Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States
Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States
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DOI：
10.1001/archsurg.143.9.832
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发表时间：
2008-09-01
影响因子：
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通讯作者：
Ko, Clifford Y.
中科院分区：
文献类型：
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作者：
Bilimoria, Karl Y.;Bentrem, Davidj.;Ko, Clifford Y.
背景：腹腔镜辅助结肠切除术（LAC）已被接受为结肠癌的治疗。然而，LAC的长期结果尚未在国家一级有经验的中心之外进行检查。目的：比较LAC和开放性结肠切除术（OC）的使用和结果。设计：回顾性队列研究。设置：国家癌症数据库。患者：接受LAC的患者（n = 11038）和OC（n = 23138 1）非转移性结肠癌（1998 - 2002）.主要结果测量：使用回归方法评估LAC与OC相比的使用和结果。腹腔镜辅助结肠切除术的使用从1998年的3.8%增加到2002年的5.2%（P <0.001）。如果患者年龄小于75岁，有私人保险，生活在高收入地区，患有I期癌症，患有下行和/或乙状结肠癌，或在国家癌症研究所指定的医院接受治疗，则患者更有可能接受LAC。与接受OC的患者相比，接受LAC的患者有12个或更多淋巴结检查的频率较低（P < .001），围手术期死亡率和复发率相似，5年生存率较高（64.1% vs 58.5%，P < .001）。在调整患者、肿瘤、治疗和医院因素后，I期和11期癌症的LAC后5年生存率显著高于OC，但III期癌症的5年生存率则无显著差异。与低容量医院相比，高容量中心的短期和长期LAC结局相当，但高容量中心的淋巴结计数显著较高（中位数，12 vs 8个淋巴结; P < .001）。结论：腹腔镜辅助结肠切除术和OC结局在人群中通常相当。然而，在选定的患者中，LAC后的生存率高于OC后。
Background: Laparoscopic-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.Objective: To compare use and outcomes of LAC and open colectomy (OC).Design: Retrospective cohort study.Setting: National Cancer Data Base.Patients: Patients who underwent LAC (n = 11038) and OC (n = 23138 1) for nonmetastatic colon cancer (19982002).Main Outcome Measures: Regression methods were used to assess use and outcomes of LAC compared with OC.Results: Laparoscopic-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 11 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).Conclusions: Laparoscopic-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.