番茄社区

Patients with locally advanced colon cancer who underwent minimally invasive surgery (MIS) were able to start adjuvant therapy more quickly than those undergoing open resections, researchers found.

In an analysis involving over 34,000 stage III colon cancer patients, 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, P<0.001), median length of hospital stay (5 vs 6 days, P<0.001), and 30-day readmission rates (4.2% vs 4.7%, P=0.039), reported David T. Pointer, MD, of the H. Lee Moffitt Cancer Center in Tampa, Florida, and colleagues.

A multi-variable analysis for predictors of delayed RIOT characterized MIS as a "favorable predictor" of early RIOT versus open resection (HR 0.793, 95% CI 0.751-0.839), Pointer's group wrote in an abstract for the virtual Society of American Gastrointestinal and Endoscopic Surgeons meeting (their presentation is scheduled for a later date).

However, Pointer and colleagues cautioned 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."

"Returning to the intended oncologic treatment as rapidly as possible is an important goal for any patient who needs both surgery and adjuvant therapy," David A. Greenwald, MD, of Mount Sinai Hospital in New York City and president of the American College of Gastroenterology, told 番茄社区.

The study "is important because it helps address a concern many patients with stage III colorectal cancer have -- patients are advised they will need both surgery and adjuvant therapy for the best outcomes and are concerned that the recovery from surgery may delay needed adjuvant therapy," said Greenwald, who was not involved in the study.

Compared to standard surgery, MIS may contribute to earlier recovery and provide patients the ability to initiate adjuvant chemotherapy early after surgery, Pointer and colleagues explained. They described RIOT as "a concept of increasing importance in surgically resected cancers requiring multimodal treatment."

For their study, Pointer and colleagues included 34,736 stage III colon adenocarcinoma patients from the National Cancer Database () who had undergone surgical resection and initiated adjuvant chemotherapy. Patients were excluded if they were diagnosed with rectosigmoid adenocarcinoma, or had incomplete data.

Two groups, an open surgical group (n=16,977) and a 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, P=0.180) and were more likely to have delayed RIOT compared to those successfully treated with MIS (HR 1.247, 95% CI 1.123-1.383, P<0.001).

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