Minimally invasive surgery bests open resections in colon cancer, finds study

USA: Minimally invasive surgery (MIS) in patients with locally advanced colon cancer is beneficial over open resections, a recent study has revealed. The study findings were presented at the virtual Society of American Gastrointestinal and Endoscopic Surgeons meeting.

According to the study, patients who underwent MIS were able to start adjuvant therapy more quickly than those undergoing open resections. However, the researchers caution that these findings should not "imply an impact on oncologic outcomes such as disease recurrence or survival" among patients with locally advanced cancer, adding, "patient selection factors may also impact these findings."

David T. Pointer, MD, of the H. Lee Moffitt Cancer Center in Tampa, Florida, and colleagues conducted an analysis involving over 34,000 stage III colon cancer patients. They found that those who underwent MIS experienced a reduction in the median time to return to intended oncological treatment (RIOT) versus open surgery (6 vs 7 weeks, respectively), median length of hospital stay (5 vs 6 days), and 30-day readmission rates (4.2% vs 4.7%).

A multi-variable analysis for predictors of delayed RIOT characterized MIS as a "favorable predictor" of early RIOT versus open resection (HR 0.793). 

Researchers included 34,736 stage III colon adenocarcinoma patients from the National Cancer Database (NCDB) who had undergone surgical resection and initiated adjuvant chemotherapy. Patients diagnosed with rectosigmoid adenocarcinoma, or those having incomplete data were excluded. 

Two groups, an open surgical group (n=16,977) and an MIS colectomy group (n=17,759) were matched by propensity scores, where time to RIOT was compared using mixed-effects modeling for each group.

Patients had a median age of 63, with an equal gender distribution among participants, the researchers said.

Nearly all patients in the MIS cohort (91.8%) underwent a laparoscopic resection, while the remainder had a robotic resection. No differences were observed in short-term outcomes or time to RIOT between the two minimally invasive approaches, the researchers said.

Among the MIS group, 13.2% had to be converted to open surgery. The researchers noted that this small group of patients experienced similar median time to RIOT as those who initially underwent open surgery (7 vs 7 weeks) and were more likely to have delayed RIOT compared to those successfully treated with MIS (HR 1.247).

Reference:

Society of American Gastrointestinal and Endoscopic Surgeons: Pointer DT, et al "Return to intended oncologic treatment (ROIT) after colectomy for stage III adenocarcinoma: Does surgical approach matter?" SAGES 2021; Abstract S182-SS34.