What is the effect of laparoscopic colectomy on pattern of colon cancer recurrence? A propensity score and competing risk analysis compared with open colectomy

Ann Surg Oncol. 2014 Aug;21(8):2627-35. doi: 10.1245/s10434-014-3613-x. Epub 2014 Mar 11.

Abstract

Background: Variability in colon cancer recurrence after laparoscopic colectomy (LAC) remains poorly understood. The aim of our study was to quantify the influence of LAC on colon cancer recurrence patterns.

Methods: We included 986 patients undergoing curative colectomy at our institution between 1992 and 2008. Kaplan-Meier, multivariable Cox regression, propensity score adjustment, and competing risks modeling were used to evaluate the influence of laparoscopic surgery on the site of colon cancer recurrence, including the following: liver metastasis, lung metastasis, local recurrence, peritoneal dissemination, other, and multiple sites. We estimated the risk factors for each recurrence site.

Results: Laparoscopic surgery was used in 419 (42.5 %) of 986 patients, with an overall median follow-up time of 5.0 years (interquartile range 3.5). The overall 5-year disease-free survival rate was 86.1 % (open surgery 81.8 % vs. laparoscopic surgery 92.0 %; p < 0.001). However, after covariates and propensity score adjustment, laparoscopic surgery was not a significant risk factor for each type of recurrence: liver hazard ratio (HR) 0.93 (95 % CI 0.45-1.89), p = 0.84; lung HR 0.67 (95 % CI 0.26-1.70), p = 0.39; local HR 0.56 (95 % CI 0.12-2.63), p = 0.46; peritoneal HR 2.49 (95 % CI 0.75-8.27), p = 0.14; others HR 0.47 (95 % CI 0.04-5.13), p = 0.53; multiple HR 0.88 (95 % CI 0.25-3.14), p = 0.84. The risk factors for each type of recurrence were variable and characterized by specific clinicopathological features.

Conclusion: Our study reveals that LAC and open colectomy demonstrate comparable overall colon cancer recurrence rates and recurrence sites. Specific clinicopathological characteristics may have a stronger influence on colon cancer recurrence site compared with the surgical technique.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Colectomy / adverse effects*
  • Colonic Neoplasms / mortality
  • Colonic Neoplasms / pathology
  • Colonic Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Laparoscopy / adverse effects*
  • Liver Neoplasms / mortality
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery
  • Lung Neoplasms / mortality
  • Lung Neoplasms / secondary
  • Lung Neoplasms / surgery
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / etiology
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Staging
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary
  • Peritoneal Neoplasms / surgery
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Prognosis
  • Propensity Score*
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate