Comparative effectiveness of laparoscopy vs open colectomy among nonmetastatic colon cancer patients: an analysis using the National Cancer Data Base.
Comparative effectiveness of laparoscopy vs open colectomy among nonmetastatic colon cancer patients: an analysis using the National Cancer Data Base.
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腹腔镜检查与开腹结肠切除术在非转移性结肠癌患者中的疗效比较：使用国家癌症数据库进行的分析。
DOI：
10.1093/jnci/dju491
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Chang,GeorgeJ
中科院分区：
文献类型：
--
作者：
Zheng,Zhiyuan;Jemal,Ahmedin;Lin,ChunChieh;Hu,Chung-Yuan;Chang,GeorgeJ
背景随机临床试验表明，腹腔镜结肠切除术（LC）在短期手术效果上优于开腹结肠切除术（OC）；方法利用国家癌症数据库识别2010年和2011年年龄为18至84岁的I-III期结肠癌患者。采用1:1匹配（PS）的倾向评分分析以避免治疗选择偏倚的影响。将患者在医院级别进行聚类以进行多级回归分析。测量的主要结果是 III 期患者的 30 天死亡率、计划外再入院、住院时间 (LOS) 和开始辅助化疗。所有统计检验均为双侧。结果共分析了 45 876 例患者，其中 18 717 例（41%）LC 和 27 159 例（59%）OC。经过 PS 匹配后，两组患者共有 18 230 名患者，并且他们的协变量平衡良好。与 OC 相比，LC 在 30 天死亡率（1.3% vs 2.3%，优势比 [OR] = 0.59，95% 置信区间 [CI] = 0.49 至 0.69，P< .001）和 LOS（中位 5 天 vs 6 天，事故率 = 0.83，95% CI = 0.8 至 0.84，P< .001）方面表现出一致的优势。 .001）。 LC 还与 III 期患者较高的辅助化疗使用率相关（72.3% vs 67.0%，P< .001）。 LC 更有可能由高通量医院的高通量外科医生进行，但医院/外科医生数量对短期结果没有显着影响。结论在常规临床实践中，与开腹结肠切除术相比，腹腔镜结肠切除术与 III 期结肠癌患者的 30 天死亡率较低、住院时间较短以及开始辅助化疗的可能性较大相关。
BackgroundRandomized clinical trials showed that laparoscopic colectomy (LC) is superior to open colectomy (OC) in short-term surgical outcomes; however, the generalizability among real-world patients is not clear.MethodsThe National Cancer Data Base was used to identify stage I-III colon cancer patients age 18 to 84 years in 2010 and 2011. A propensity score analysis with 1:1 matching (PS) was used to avoid the effect of treatment selection bias. Patients were clustered at the hospital level for multilevel regression analyses. The main outcomes measured were 30-day mortality, unplanned readmissions, length of stay (LOS), and initiation of adjuvant chemotherapy among stage III patients. All statistical tests were two-sided.ResultsA total of 45 876 patients were analyzed, 18 717 (41%) LC and 27 159 (59%) OC. After PS matching, there were 18 230 patients in both groups and they were well balanced on their covariables. Compared with OC, LC showed consistent benefits in 30-day mortality (1.3% vs 2.3 %, odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.49 to 0.69,P< .001) and LOS (median 5 vs 6 days, incident rate ratio = 0.83, 95% CI = 0.8 to 0.84,P< .001). LC was also associated with a higher rate of adjuvant chemotherapy use in stage III patients (72.3% vs 67.0%,P< .001). LC was more likely to be performed by high-volume surgeons in high-volume hospitals, but there was no significant effect of the hospital/surgeon volume on short-term outcomes.ConclusionIn routine clinical practice, laparoscopic colectomy is associated with lower 30-day mortality, shorter length of stay, and greater likelihood of adjuvant chemotherapy initiation among stage III colon cancer patients when compared with open colectomy.
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影响因子：
168.9
作者：
Lacy, AM;García-Valdecasas, JC;Visa, J
通讯作者：
Visa, J
腹腔镜结肠切除术在结肠癌中的应用现状和手术效果。
影响因子：
5.2
作者：
Sticca,RobertP;Alberts,StevenR;Mahoney,MichelleR;Sargent,DanielJ;Finstuen,LisaM;Nelson,GarthD;Husted,TimothyM;Franko,Jan;Goldman,CharlesD;Pockaj,BarbaraA
通讯作者：
Pockaj,BarbaraA
腹腔镜辅助与开腹结肠切除术治疗结肠癌：荟萃分析
DOI：
10.1016/s0739-5930(08)79222-5
发表时间：
2008
期刊：
Yearbook of Gastroenterology
影响因子：
--
作者：
J. Rombeau
通讯作者：
J. Rombeau
学术医疗中心在结直肠癌手术中使用腹腔镜手术：手术部位是否会影响腹腔镜手术率？
DOI：
--
发表时间：
2011
期刊：
The American surgeon
影响因子：
--
作者：
J. Carmichael;H. Masoomi;S. Mills;M. Stamos;N. Nguyen
通讯作者：
N. Nguyen
影响因子：
9
作者：
Osler, Merete;Iversen, Lene H.;Frederiksen, Birgitte
通讯作者：
Frederiksen, Birgitte