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Successful and Safe Introduction of Laparoscopic Colorectal Cancer Surgery in Dutch Hospitals

Kolfschoten, Nikki E. MD*; van Leersum, Nicoline J. MD*; Gooiker, Gea A. MD*; van de Mheen, Perla J. Marang PhD; Eddes, Eric-Hans PhD, MD§; Kievit, Job PhD, MD*,†; Brand, Ronald PhD; Tanis, Pieter J. PhD, MD; Bemelman, Willem A. PhD, MD; Tollenaar, Rob A. E. M. PhD, MD*; Meijerink, Jeroen PhD, MD; Wouters, Michel W. J. M. MD#

doi: 10.1097/SLA.0b013e31825d0f37
Original Articles

Objective: To investigate the safety of laparoscopic colorectal cancer resections in a nationwide population-based study.

Background: Although laparoscopic techniques are increasingly used in colorectal cancer surgery, little is known on results outside trials. With the fast introduction of laparoscopic resection (LR), questions were raised about safety.

Methods: Of all patients who underwent an elective colorectal cancer resection in 2010 in the Netherlands, 93% were included in the Dutch Surgical Colorectal Audit. Short-term outcome after LR, open resection (OR), and converted LR were compared in a generalized linear mixed model. We further explored hospital differences in LR and conversion rates.

Results: A total of 7350 patients, treated in 90 hospitals, were included. LR rate was 41% with a conversion rate of 15%. After adjustment for differences in case-mix, LR was associated with a lower risk of mortality (odds ratio 0.63, P < 0.01), major morbidity (odds ratio 0.72, P < 0.01), any complications (odds ratio 0.74, P < 0.01), hospital stay more than 14 days (odds ratio 0.71, P < 0.01), and irradical resections (odds ratio 0.68, P < 0.01), compared to OR. Outcome after conversion was similar to OR (P > 0.05). A large variation in LR and conversion rates among hospitals was found; however, the difference in outcome associated with operative techniques was not influenced by hospital of treatment.

Conclusions: Use of laparoscopic techniques in colorectal cancer surgery in the Netherlands is safe and results are better in short-term outcome than open surgery, irrespective of the hospital of treatment. Outcome after conversion was similar to OR.

This study shows, using a nationwide population-based database, that the use of laparoscopic techniques in colorectal cancer surgery in The Netherlands is safe and results in better short-term outcome than open surgery, irrespective of the hospital of treatment, whereas outcome after conversion was similar to open resection.

*Department of Surgery

Medical Decision Making and

Biostatistics, Leiden University Medical Center, The Netherlands

§Department of Surgery, Deventer Hospital, Deventer, The Netherlands

Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands

Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands

#Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Reprints: Rob A. E. M. Tollenaar, MD, PhD, Leiden University Medical Centre, K6-R, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail: r.a.e.m.tollenaar@lumc.nl.

Disclosure: The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.