OBJECTIVES: Previous randomized trials and observational studies have shown only comparable survival benefits for colon cancer patients undergoing colectomy with laparoscopic versus conventional open surgery. Although laparoscopic surgery has become a preferred approach, its survival benefits have not been adequately examined in a recent colon cancer cohort. We therefore assessed in a real-world Medicare population short- and long-term survival among early-stage colon cancer patients treated with laparoscopic-assisted colectomy (LAC) versus open colectomy (OC).
METHODS: In this retrospective observational cohort study, early-stage colon cancer patients aged =65 years who received colectomy within 6 months of diagnosis were selected from the Surveillance Epidemiology and End Results-Medicare database (2004-2009). Patients undergoing LAC were propensity matched to those receiving OC on demographic and clinical characteristics (stage at diagnosis, tumor size, and comorbidities). Short-term (1-year) and long-term (5-year) overall survival rates, and survival times were assessed using Kaplan-Meier methods for the overall cohort and separately by patients diagnosed with local- versus regional-stage disease.
RESULTS: A total of 10,073 early-stage cancer patients met the study inclusion criteria (55% female; median age 77.8 years). Of total, 60.2% were diagnosed with local-stage and 39.8% with regional-stage disease at diagnosis. The 1-year survival did not differ between LAC and OC groups for the overall cohort and local-stage patients, but was significantly higher in the LAC group for regional-stage patients (98.4% vs. 97.4%; p<0.05). The 5-year survival was significantly better in the LAC (vs. OC) group for the overall cohort (63.2% vs. 59.8%; p<0.05) and regional-stage patients (54.9% vs. 48.5%; p<0.01). Regional-stage patients treated with LAC also had longer survival time (5.5 vs. 4.7 years; p<0.01).
CONCLUSIONS: Results of this study indicate that LAC was associated with greater long-term overall survival rate and survival time versus OC among elderly early-stage colon cancer patients, particularly those with regional-stage disease at diagnosis.
