Effects of laparoscopic surgery on survival, quality of care and utilization in patients with colon cancer: a population-based study

Abstract

Objective: Laparoscopy is a safe and effective treatment for colon cancer. However, its effects on short- and long-term health outcomes and medical utilization are not fully elucidated. This study aimed to compare short- and long-term utilization and health outcomes of colon cancer patients who underwent either laparoscopic or open surgery in a population-based cohort.

Methods: This study was conducted by linking data from Taiwan Cancer Registry, National Health Insurance claims and Death Registry. Patients aged 18 and older with colon cancer between 2009 and 2012 were included in the study. Propensity score matching was used to minimize selection bias between laparoscopic and open surgery groups. Cox proportional hazard regression and generalized linear mixed logistic regression were used to test hypotheses.

Results: Among the 11,269 colon cancer patients who underwent colectomy, 3236 (28.72%) received laparoscopy and 8033 (71.28%) underwent open surgery. Patients who received laparoscopic surgery had better overall survival (HR = 0.82; 95% CI: 0.70–0.97). These patients also had lower 30 day mortality (0.44% vs. 0.91%), lower 1 year mortality (2.83% vs. 4.68%), lower overall occurrence of complications (6.16% vs. 8.77%), shorter mean length of stay (12.53 vs. 14.93 days) and lower cost for index hospitalization (US$4325.34 vs. US$4453.90). No significant differences were observed in medical utilization over a period of 365 days after the surgery.

Conclusions: Our results demonstrate that, in both the short- and long-term post-operation periods, laparoscopic surgery reduced the likelihood of postoperative complications, 30 day, and 1 year mortality while being no more expensive than open surgery for colon cancer.

Keywords:

• Laparoscopy
• colon cancer
• healthcare utilization
• survival
• complications

Transparency

Declaration of funding

This study was supported by Covidien. Covidien provided the Investigator Sponsored Research grant which includes the expense of applying for IRB approval and applying for the database. However, Covidien played no role in the preparation, review or approval of the manuscript, or in the decision on submit the manuscript for publication. All of the work and opinions presented in this manuscript are solely those of the authors.

Author contributions: E.C.T., M.-C.Y. and C.-C.C. were involved in the study concept and design. E.T. was involved in statistical analysis. E.C.T., M.-C.Y. and C.-C.C. were involved in drafting of the manuscript and critical revision of the manuscript. M.-C.Y. was involved in study supervision.

Declaration of financial/other relationships

E.C.T., M.-C.Y. and C.-C.C. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

None reported.