Minimally invasive surgery shows benefit in colon cancer

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

In an analysis of more than 34,000 patients with stage III colon cancer, those who underwent MIS experienced a reduction in the median time to return to planned oncologic treatment (RIOT) compared to open surgery ( 6 versus 7 weeks, respectively, PPP= 0.039), reported David T. Pointer, MD, of the H. Lee Moffitt Cancer Center in Tampa, Fla., And colleagues.

A multivariate analysis of predictors of delayed RIOT characterized MIS as a “favorable predictor” of early RIOT compared to open resection (HR 0.793, 95% CI 0.751-0.839), Pointer’s group wrote in an abstract for 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 findings such as disease recurrence or survival” in patients with locally advanced cancer, adding that “the factors of patient selection may also have an impact on these results ”.

“Getting back to planned oncology treatment as quickly 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 and President of the American College of Gastroenterology, Narrated MedPage today.

The study “is important because it addresses a concern of many patients with stage III colorectal cancer: patients are informed that they will need both surgery and adjuvant therapy. for the best results and are concerned that recovery from surgery may delay needed adjuvant therapy, ”said Greenwald, who was not in the study.

Compared to standard surgery, MIS can contribute to faster recovery and offer patients the option to initiate adjuvant chemotherapy soon after surgery, explained Pointer and colleagues. 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 patients with stage III colon adenocarcinoma from the National Cancer Database (BNDC) who had undergone surgical resection and initiated adjuvant chemotherapy. Patients were excluded if they had been diagnosed with rectosigmoid adenocarcinoma or if they had incomplete data.

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 effect modeling mixed for each group.

The patients had a median age of 63, with an even gender distribution among the participants, the researchers said.

Almost all of the patients in the MIS cohort (91.8%) underwent laparoscopic resection, while the rest underwent robotic resection. No difference was seen 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 a similar median time to RIOT than those who initially had 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

Last updated on September 07, 2021

  • Zaina Hamza is a writer for MedPage Today, covering gastroenterology and infectious diseases. She is based in Chicago.

Disclosures

The authors did not report any conflicts of interest.


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