手术方法和在结直肠癌手术后的长期存活率的变化,使用仪器变量分析
Cody Lendon Mullens1,2,3, Sarah Sheskey2, Edward C Norton3,4,5
1From the Department of Surgery, University of Michigan, Ann Arbor, MI.
概括
结肠和直肠癌的微创手术改善了长期的生存率. 然而,这些技术的扩展并没有导致相应的生存率增加,这表明它们不是改善患者结果的唯一策略.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 流行病学 流行病学
背景情况:
- 对结肠和直肠癌的手术方法进行比较的现有数据受到选择偏差的限制.
- 需要更好的因果推理方法来理解手术方法与长期存活之间的关系.
研究的目的:
- 为了确定与开放手术相比,增加微创手术方法的使用是否会改善结肠和直肠癌切除后的长期存活率.
主要方法:
- 使用仪器变量 (IV) 方法,使用美国外科医生学院国家癌症数据库 (2011-2018) 的数据.
- 仪器变量是医院区域内的机器人辅助手术率.
- 对机器人,腹腔镜和开放方法的风险调整后死亡率估计的比例危险建模.
主要成果:
- 包括326,406名结肠癌和96,979名直肠癌患者.
- 至少侵入性的方法 (机器人,腹腔镜) 与开放式手术相比,显示了较低的5年死亡率.
- 微创手术利用率的增长超过了长期生存率的改善.
结论:
- 最少侵入性的外科手术方法与结肠和直肠癌患者的长期生存率的改善有关.
- 最少侵入性技术的扩展与相应的生存率改善没有相关性.
- 仅仅增加微创疗法可能是不够的策略来改善长期患者的治疗结果.
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