Chinese journal of cancer research = Chung-kuo yen cheng yen chiu · 2024
Long-term survival outcomes of laparoscopic surgery in patients with colorectal cancer: A propensity score matching retrospective cohort study.
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Tian Ruoxi, Li Jiyun, Huang Fei, Cheng Pu, Bao Mandoula, Zhao Liming, Zheng Zhaoxu
Аннотация
OBJECTIVE: Colorectal cancer (CRC) surgeries can be performed using either laparoscopic or open laparotomy approaches. However, the long-term outcomes based on tumor location and age remain unclear. This study compared the long-term outcomes of laparoscopic and laparotomy surgeries in patients with CRC, focusing on tumor location and age to identify suitable subgroups and determine an optimal cut-off age.
METHODS: This retrospective study analyzed 2,014 patients with CRC who underwent radical surgery. Patients were categorized into laparoscopy and laparotomy groups, and propensity score matching (PSM) was performed. Kaplan-Meier analysis, log-rank tests, and Cox regression models were used to identify the independent factors affecting overall survival (OS).
RESULTS: Analysis results before PSM indicated higher OS in the laparoscopy group (P=0.035); however, it was no significant difference in mean OS between the two groups after PSM analysis. Cox regression analysis identified several factors influencing the OS of patients with CRC, with age, T stage, nodal involvement, poorly differentiated adenocarcinoma, ascites, preoperative intestinal obstruction, and local tumor spread as independent risk factors. Family history was a protective factor [hazard ratio (HR)=0.33; 95% CI, 0.16-0.68; P=0.002], and the surgical modality did not independently affect OS. The subgroup analysis highlighted the advantages of laparoscopic surgery in specific subgroups.
CONCLUSIONS: Overall, laparoscopic and laparotomy surgeries resulted in similar mid- and long-term prognoses for patients with CRC. Laparoscopic surgery showed better outcomes in specific subgroups, particularly in patients aged >60 years and in those with right-sided colon carcinoma. This study suggests that age >64 years might be the optimal cut-off age for laparoscopic surgery.
METHODS: This retrospective study analyzed 2,014 patients with CRC who underwent radical surgery. Patients were categorized into laparoscopy and laparotomy groups, and propensity score matching (PSM) was performed. Kaplan-Meier analysis, log-rank tests, and Cox regression models were used to identify the independent factors affecting overall survival (OS).
RESULTS: Analysis results before PSM indicated higher OS in the laparoscopy group (P=0.035); however, it was no significant difference in mean OS between the two groups after PSM analysis. Cox regression analysis identified several factors influencing the OS of patients with CRC, with age, T stage, nodal involvement, poorly differentiated adenocarcinoma, ascites, preoperative intestinal obstruction, and local tumor spread as independent risk factors. Family history was a protective factor [hazard ratio (HR)=0.33; 95% CI, 0.16-0.68; P=0.002], and the surgical modality did not independently affect OS. The subgroup analysis highlighted the advantages of laparoscopic surgery in specific subgroups.
CONCLUSIONS: Overall, laparoscopic and laparotomy surgeries resulted in similar mid- and long-term prognoses for patients with CRC. Laparoscopic surgery showed better outcomes in specific subgroups, particularly in patients aged >60 years and in those with right-sided colon carcinoma. This study suggests that age >64 years might be the optimal cut-off age for laparoscopic surgery.