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Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort

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Abstract

Background

Randomized trials show similar outcomes after open surgery and laparoscopy for colon cancer, and confirmation of outcomes after implementation in routine practice is important. While some studies have reported long-term outcomes after laparoscopic surgery from single institutions, data from large patient cohorts are sparse. We investigated short- and long-term outcomes of laparoscopic and open surgery for treating colon cancer in a large national cohort.

Methods

We retrieved data from the Norwegian Colorectal Cancer Registry for all colon cancer resections performed in 2007–2010. Five-year relative survival rates following laparoscopic and open surgeries were calculated, including excess mortality rates associated with potential predictors of death.

Results

Among 8707 patients with colon cancer that underwent major resections, 16 % and 36 % received laparoscopic procedures in 2007 and 2010, respectively. Laparoscopic procedures were most common in elective surgeries for treating stages I–III, right colon, or sigmoid tumours. The conversion rate of laparoscopic procedures was 14.5 %. Among all patients, laparoscopy provided higher 5-year relative survival rates (70 %) than open surgery (62 %) (P = 0.040), but among the largest group of patients electively treated for stages I–III disease, the approaches provided similar relative survival rates (78 vs. 81 %; P = 0.535). Excess mortality at 2 years post-surgery was lower after laparoscopy than after open surgery (excess hazard ratio, 0.7; P = 0.013), but similar between groups during the last 3 years of follow-up. Major predictors of death were stage IV disease, tumour class pN+, age > 80 years, and emergency procedures (excess hazard ratios were 5.3, 2.4, 2.1, and 2.0, respectively; P < 0.001).

Conclusion

Nationwide implementation of laparoscopic colectomy for colon cancer was safe and achieved results comparable to those from previous randomized trials.

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Acknowledgments

This study used data from the Cancer Registry of Norway. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Cancer Registry of Norway is intended nor should be inferred. The authors are grateful for financial support provided by the Folke Hermansen Fund for Cancer Research at Stavanger University Hospital, and for valuable advice and comments from the members of the Norwegian Colorectal Cancer Group.

Disclosures

This study was funded by Folke Hermansen’s Fund for Cancer Research at Stavanger University Hospital, Grant #424507. The funding institution did not have any influence on the process of analysis of data, interpretation of results or preparation of the present manuscript. None of the authors (Drs. K. Stormark, K. Søreide, J.A. Søreide, J.T. Kvaløy, F. Pfeffer, M.T. Eriksen, B.S. Nedrebø, and H. Kørner) have any conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway

    Kjartan Stormark, Kjetil Søreide, Jon Arne Søreide, Bjørn S. Nedrebø & Hartwig Kørner

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    Kjartan Stormark, Kjetil Søreide, Jon Arne Søreide, Frank Pfeffer & Hartwig Kørner

  3. Department of Mathematics and Natural Sciences, University of Stavanger, Stavanger, Norway

    Jan Terje Kvaløy

  4. Department of Gastrointestinal and Acute Surgery, Haukeland University Hospital, Bergen, Norway

    Frank Pfeffer

  5. Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway

    Morten T. Eriksen

  6. Research Department, Stavanger University Hospital, Stavanger, Norway

    Jan Terje Kvaløy

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  1. Kjartan Stormark
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  2. Kjetil Søreide
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Correspondence to Hartwig Kørner.

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On behalf of the Norwegian Colorectal Cancer Group.

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Stormark, K., Søreide, K., Søreide, J.A. et al. Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort. Surg Endosc 30, 4853–4864 (2016). https://doi.org/10.1007/s00464-016-4819-8

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