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Uptake and outcomes of laparoscopically assisted resection for colon and rectal cancer in Australia: a
Timothy A Dobbins1, Jane M Young, Michael J Solomon
11Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia 2Cancer Institute of New South Wales, Everleigh, New South Wales, Australia 3Surgical Outcomes Research Centre, Sydney Local Health District, Sydney, New South Wales, Australia 4Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 5Discipline of Surgery, Sydney School of Medicine, University of Sydney, Sydney, New South Wales, Australia.
Background:
Meta-analyses of randomized controlled trials support the use of laparoscopically assisted resection for colon cancer. The evidence supporting its use in rectal cancer is weak.
Objective:
The purpose of this work was to investigate the uptake of laparoscopically assisted resection for colon and rectal cancer and to compare short- and long-term outcomes using population data.
Design:
This was a retrospective cohort study using linked administrative health data.
Settings:
The study encompassed all of the public and private hospitals in New South Wales, Australia, between 2000 and 2008.
Patients:
A total of 27,947 patients with colon or rectal cancer undergoing surgery with curative intent were included in the study.
Main Outcome Measures:
We summarized the proportion of resections performed laparoscopically. Short-term outcomes were extended stay, 28-day readmission, 28-day emergency readmission, 30- and 90-day mortality, and 90-day readmission with pulmonary embolism or deep-vein thrombosis. Long-term outcomes were all-cause and cancer-specific death and admission with obstruction or incisional hernia repair.
Results:
Laparoscopic procedures increased between 2000 and 2008 for colon (1.5%-20.7%) and rectal cancer (0.6%-15.5%). Laparoscopic procedures reduced rates of extended stay (OR, 0.60; 95% CI, 0.49-0.72) and 28-day readmission (OR, 0.86; 95% CI, 0.74-0.99) for colon cancer. For rectal cancer, laparoscopic procedures had lower rates of 28-day readmission (OR, 0.58; 95% CI, 0.42-0.78) and 28-day emergency readmission (OR, 0.54; 95% CI, 0.34-0.85). Laparoscopic procedures improved cancer-specific survival for rectal cancer (HR, 0.71; 95% CI, 0.51-1.00). Survival benefits were observed for laparoscopically assisted colon resection in higher-caseload hospitals but not lower-caseload hospitals.
Limitations:
It was not possible to identify laparoscopically assisted resections converted to open procedures because of the claims-based nature of the data.
Conclusions:
Despite increases in laparoscopically assisted resections for colon and rectal cancer, the majority of resections are still treated by open procedures. Our data suggest that laparoscopic resection reduces the lengths of stay and rates of readmission and may result in improved cancer-specific survival for both colon and rectal resections.
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