• Karl Y Bilimoria, David J Bentrem, Heidi Nelson, Steven J Stryker, Andrew K Stewart, Nathaniel J Soper, Thomas R Russell, and Clifford Y Ko.
• Department of Surgery, Feinberg School of Medicine, Northwestern University, and Cancer Programs, American College of Surgeons, Chicago, Illinois 60611, USA. kbilimoria@facs.org
• Arch Surg. 2008 Sep 1; 143 (9): 832-9; discussion 839-40.

BackgroundLaparoscopic-assisted colectomy (LAC) has gained acceptance for the treatment of colon cancer. However, long-term outcomes of LAC have not been examined at the national level outside of experienced centers.ObjectiveTo compare use and outcomes of LAC and open colectomy (OC).DesignRetrospective cohort study.SettingNational Cancer Data Base.PatientsPatients who underwent LAC (n = 11 038) and OC (n = 231 381) for nonmetastatic colon cancer (1998-2002).Main Outcome MeasuresRegression methods were used to assess use and outcomes of LAC compared with OC.ResultsLaparoscopic-assisted colectomy use increased from 3.8% in 1998 to 5.2% in 2002 (P < .001). Patients were significantly more likely to undergo LAC if they were younger than 75 years, had private insurance, lived in higher-income areas, had stage I cancer, had descending and/or sigmoid cancers, or were treated at National Cancer Institute-designated hospitals. Compared with those undergoing OC, patents undergoing LAC had 12 or more nodes examined less frequently (P < .001), similar perioperative mortality and recurrence rates, and higher 5-year survival rates (64.1% vs 58.5%, P < .001). After adjusting for patient, tumor, treatment, and hospital factors, 5-year survival was significantly better after LAC compared with OC for stage I and II but not for stage III cancer. Highest-volume centers had comparable short- and long-term LAC outcomes compared with lowest-volume hospitals, except highest-volume centers had significantly higher lymph node counts (median, 12 vs 8 nodes; P < .001).ConclusionsLaparoscopic-assisted colectomy and OC outcomes are generally comparable in the population. However, survival was better after an LAC than after an OC in select patients.

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