Laparoscopic surgery facilitates administration of adjuvant chemotherapy in locally advanced colon cancer: Propensity score analyses

Karin A. T. G. M. Wasmann, Charlotte E. L. Klaver, Jarmila D. W. van der Bilt, Susan van Dieren, Iris D. Nagtegaal, Cornelis J. A. Punt, Bert van Ramshorst, Albert M. Wolthuis, Johannes H. W. de Wilt, André D’hoore, Hjalmar C. van Santvoort, Pieter J. Tanis

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose: The aim of this study was to evaluate the impact of a laparoscopic approach on long-term oncological outcomes in curative intent surgery for pT4 colon cancer, in both overall and stratified subgroups with distinct clinical entities. Patients and methods: Patients with a pT4N0-2M0 colon cancer from four centers between 2000 and 2014 were included. Laparoscopic and open approaches were compared according to the intention-to-treat principle. Propensity scores were used to adjust for baseline differences between the groups in three manners: i) as a linear predictor in a Cox regression model, ii) to create a 1:1 matched cohort, and iii) to stratify patients into four groups with an increasing chance of receiving laparoscopy. Results: In total, 424 patients were included. After 1:1 matching, a laparoscopic approach correlated with higher rates of radical resection, lower morbidity, and a higher percentage of patients receiving adjuvant chemotherapy. This translated into better 5-year disease-free survival (52% vs 40%, HR 0.70; 95% CI 0.50–0.96) and 5-year overall survival (68% vs 57%, HR 0.66; 95% CI 0.43–0.99). These results were confirmed in the other two propensity score analyses. In the multivariable models, adjuvant chemotherapy remained independently associated with better survival, whereas surgical approach lost significance. Conclusions: In locally advanced colon cancer, an intentional laparoscopic approach in experienced hands seems to decrease morbidity and to increase the proportion of patients receiving adjuvant chemotherapy. Receiving adjuvant chemotherapy was independently associated with improved survival.
Original languageEnglish
Pages (from-to)7141-7157
JournalCancer management and research
Volume11
DOIs
Publication statusPublished - 1 Jan 2019
Externally publishedYes

Cite this

Wasmann, Karin A. T. G. M. ; Klaver, Charlotte E. L. ; van der Bilt, Jarmila D. W. ; van Dieren, Susan ; Nagtegaal, Iris D. ; Punt, Cornelis J. A. ; van Ramshorst, Bert ; Wolthuis, Albert M. ; de Wilt, Johannes H. W. ; D’hoore, André ; van Santvoort, Hjalmar C. ; Tanis, Pieter J. / Laparoscopic surgery facilitates administration of adjuvant chemotherapy in locally advanced colon cancer: Propensity score analyses. In: Cancer management and research. 2019 ; Vol. 11. pp. 7141-7157.
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title = "Laparoscopic surgery facilitates administration of adjuvant chemotherapy in locally advanced colon cancer: Propensity score analyses",
abstract = "Purpose: The aim of this study was to evaluate the impact of a laparoscopic approach on long-term oncological outcomes in curative intent surgery for pT4 colon cancer, in both overall and stratified subgroups with distinct clinical entities. Patients and methods: Patients with a pT4N0-2M0 colon cancer from four centers between 2000 and 2014 were included. Laparoscopic and open approaches were compared according to the intention-to-treat principle. Propensity scores were used to adjust for baseline differences between the groups in three manners: i) as a linear predictor in a Cox regression model, ii) to create a 1:1 matched cohort, and iii) to stratify patients into four groups with an increasing chance of receiving laparoscopy. Results: In total, 424 patients were included. After 1:1 matching, a laparoscopic approach correlated with higher rates of radical resection, lower morbidity, and a higher percentage of patients receiving adjuvant chemotherapy. This translated into better 5-year disease-free survival (52{\%} vs 40{\%}, HR 0.70; 95{\%} CI 0.50–0.96) and 5-year overall survival (68{\%} vs 57{\%}, HR 0.66; 95{\%} CI 0.43–0.99). These results were confirmed in the other two propensity score analyses. In the multivariable models, adjuvant chemotherapy remained independently associated with better survival, whereas surgical approach lost significance. Conclusions: In locally advanced colon cancer, an intentional laparoscopic approach in experienced hands seems to decrease morbidity and to increase the proportion of patients receiving adjuvant chemotherapy. Receiving adjuvant chemotherapy was independently associated with improved survival.",
author = "Wasmann, {Karin A. T. G. M.} and Klaver, {Charlotte E. L.} and {van der Bilt}, {Jarmila D. W.} and {van Dieren}, Susan and Nagtegaal, {Iris D.} and Punt, {Cornelis J. A.} and {van Ramshorst}, Bert and Wolthuis, {Albert M.} and {de Wilt}, {Johannes H. W.} and Andr{\'e} D’hoore and {van Santvoort}, {Hjalmar C.} and Tanis, {Pieter J.}",
year = "2019",
month = "1",
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doi = "10.2147/CMAR.S205906",
language = "English",
volume = "11",
pages = "7141--7157",
journal = "Cancer management and research",
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Wasmann, KATGM, Klaver, CEL, van der Bilt, JDW, van Dieren, S, Nagtegaal, ID, Punt, CJA, van Ramshorst, B, Wolthuis, AM, de Wilt, JHW, D’hoore, A, van Santvoort, HC & Tanis, PJ 2019, 'Laparoscopic surgery facilitates administration of adjuvant chemotherapy in locally advanced colon cancer: Propensity score analyses' Cancer management and research, vol. 11, pp. 7141-7157. https://doi.org/10.2147/CMAR.S205906

Laparoscopic surgery facilitates administration of adjuvant chemotherapy in locally advanced colon cancer: Propensity score analyses. / Wasmann, Karin A. T. G. M.; Klaver, Charlotte E. L.; van der Bilt, Jarmila D. W.; van Dieren, Susan; Nagtegaal, Iris D.; Punt, Cornelis J. A.; van Ramshorst, Bert; Wolthuis, Albert M.; de Wilt, Johannes H. W.; D’hoore, André; van Santvoort, Hjalmar C.; Tanis, Pieter J.

In: Cancer management and research, Vol. 11, 01.01.2019, p. 7141-7157.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Laparoscopic surgery facilitates administration of adjuvant chemotherapy in locally advanced colon cancer: Propensity score analyses

AU - Wasmann, Karin A. T. G. M.

AU - Klaver, Charlotte E. L.

AU - van der Bilt, Jarmila D. W.

AU - van Dieren, Susan

AU - Nagtegaal, Iris D.

AU - Punt, Cornelis J. A.

AU - van Ramshorst, Bert

AU - Wolthuis, Albert M.

AU - de Wilt, Johannes H. W.

AU - D’hoore, André

AU - van Santvoort, Hjalmar C.

AU - Tanis, Pieter J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: The aim of this study was to evaluate the impact of a laparoscopic approach on long-term oncological outcomes in curative intent surgery for pT4 colon cancer, in both overall and stratified subgroups with distinct clinical entities. Patients and methods: Patients with a pT4N0-2M0 colon cancer from four centers between 2000 and 2014 were included. Laparoscopic and open approaches were compared according to the intention-to-treat principle. Propensity scores were used to adjust for baseline differences between the groups in three manners: i) as a linear predictor in a Cox regression model, ii) to create a 1:1 matched cohort, and iii) to stratify patients into four groups with an increasing chance of receiving laparoscopy. Results: In total, 424 patients were included. After 1:1 matching, a laparoscopic approach correlated with higher rates of radical resection, lower morbidity, and a higher percentage of patients receiving adjuvant chemotherapy. This translated into better 5-year disease-free survival (52% vs 40%, HR 0.70; 95% CI 0.50–0.96) and 5-year overall survival (68% vs 57%, HR 0.66; 95% CI 0.43–0.99). These results were confirmed in the other two propensity score analyses. In the multivariable models, adjuvant chemotherapy remained independently associated with better survival, whereas surgical approach lost significance. Conclusions: In locally advanced colon cancer, an intentional laparoscopic approach in experienced hands seems to decrease morbidity and to increase the proportion of patients receiving adjuvant chemotherapy. Receiving adjuvant chemotherapy was independently associated with improved survival.

AB - Purpose: The aim of this study was to evaluate the impact of a laparoscopic approach on long-term oncological outcomes in curative intent surgery for pT4 colon cancer, in both overall and stratified subgroups with distinct clinical entities. Patients and methods: Patients with a pT4N0-2M0 colon cancer from four centers between 2000 and 2014 were included. Laparoscopic and open approaches were compared according to the intention-to-treat principle. Propensity scores were used to adjust for baseline differences between the groups in three manners: i) as a linear predictor in a Cox regression model, ii) to create a 1:1 matched cohort, and iii) to stratify patients into four groups with an increasing chance of receiving laparoscopy. Results: In total, 424 patients were included. After 1:1 matching, a laparoscopic approach correlated with higher rates of radical resection, lower morbidity, and a higher percentage of patients receiving adjuvant chemotherapy. This translated into better 5-year disease-free survival (52% vs 40%, HR 0.70; 95% CI 0.50–0.96) and 5-year overall survival (68% vs 57%, HR 0.66; 95% CI 0.43–0.99). These results were confirmed in the other two propensity score analyses. In the multivariable models, adjuvant chemotherapy remained independently associated with better survival, whereas surgical approach lost significance. Conclusions: In locally advanced colon cancer, an intentional laparoscopic approach in experienced hands seems to decrease morbidity and to increase the proportion of patients receiving adjuvant chemotherapy. Receiving adjuvant chemotherapy was independently associated with improved survival.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31534367

U2 - 10.2147/CMAR.S205906

DO - 10.2147/CMAR.S205906

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EP - 7157

JO - Cancer management and research

JF - Cancer management and research

SN - 1179-1322

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