Open surgery induces a dramatic decrease in circulating intact IGFBP-3 in patients with colorectal cancer not seen with laparoscopic surgery

743 Background: Fast Track Multi-Discipline Treatment (FTMDT) integrates fast-track perioperative treatment (laparoscopic or open surgery) plus XELOX adjuvant chemotherapy for colorectal cancer (CRC). This study aimed to verify the effects of FTMDT model and to clarify the value of laparoscopic surgery in fast-track perioperative treatment. Methods: The study (NCT01080547) was a prospective randomized controlled multi-centers study. Group I (FTMDT) received fast-track treatment plus XELOX chemotherapy (Group Ia received laparoscopic surgery and Group Ib received open surgery). Group II (conventional treatment, CT) received conventional treatment plus mFOLFOX6 chemotherapy (Group IIa received laparoscopic surgery and Group IIb received open surgery). The primary endpoint was total hospital stays during treatment. The secondary endpoints included surgical complications, chemotherapy related adverse events, quality of life and hospitalization costs. Results: Between April 2010 and June 2014, 374 patients were enrolled and 342 patients were finally analyzed. The total hospital stays were shorter in FTMDT than CT (median 13 days vs. 23.5 days, P= 0.0001) but similar between Group Ia and Group Ib (median 13 days vs. 14 days, P= 0.1951). The postoperative hospital stays were shorter in FTMDT than CT (median 6 days vs. 9 days, P= 0.0001) but similar between Group Ia and Group Ib (median 6 days vs. 6 days, P= 0.2160). Resume of flatus and defecation was earlier in FTMDT ( P< 0.05) and Group Ia was the earliest. The in-hospital complication rate was lower in FTMDT (6.40% vs. 14.71%, P= 0.014) but similar between Group Ia and Group Ib. The surgery cost of Group Ib was the lowest ( P< 0.05). The rate of chemotherapy related adverse events was similar between FTMDT and CT( P> 0.05). The EORTC QLQ-C30 physical functioning and fatigue in one week postoperative were better in FTMDT than CT( P< 0.05). Conclusions: FTMDT model enhanced the postoperative recovery of CRC patients. On the premise of fast-track perioperative treatment, laparoscopic surgery showed minor advantage over open surgery which had economic advantages. Clinical trial information: NCT01080547.

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Economic evaluation of laparoscopic surgery for colorectal cancer

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462307070559 ◽

2007 ◽

Vol 23 (4) ◽

pp. 464-472 ◽

Cited By ~ 7

Author(s):

Robyn M. de Verteuil ◽

Rodolfo A. Hernández ◽

Luke Vale ◽

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Laparoscopic Surgery ◽

Cost Effectiveness ◽

Incremental Cost ◽

Open Surgery ◽

Disease Free Survival ◽

Cost Effective ◽

Economic Evaluations ◽

Short Term

Objectives: The aim of this study was to assess the cost-effectiveness of laparoscopic surgery compared with open surgery for the treatment of colorectal cancer.Methods: A Markov model was developed to model cost-effectiveness over 25 years. Data on the clinical effectiveness of laparoscopic and open surgery for colorectal cancer were obtained from a systematic review of the literature. Data on costs came from a systematic review of economic evaluations and from published sources. The outcomes of the model were presented as the incremental cost per life-year gained and using cost-effectiveness acceptability curves to illustrate the likelihood that a treatment was cost-effective at various threshold values for society's willingness to pay for an additional life-year.Results: Laparoscopic surgery was on average £300 more costly and slightly less effective than open surgery and had a 30 percent chance of being cost-effective if society is willing to pay £30,000 for a life-year. One interpretation of the available data suggests equal survival and disease-free survival. Making this assumption, laparoscopic surgery had a greater chance of being considered cost-effective. Presenting the results as incremental cost per quality-adjusted life-year (QALY) made no difference to the results, as utility data were poor. Evidence suggests short-term benefits after laparoscopic repair. This benefit would have to be at least 0.01 of a QALY for laparoscopic surgery to be considered cost-effective.Conclusions: Laparoscopic surgery is likely to be associated with short-term quality of life benefits, similar long-term outcomes, and an additional £300 per patient. A judgment is required as to whether the short-term benefits are worth this extra cost.

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Mid-term Results of Laparoscopic Surgery and Open Surgery for Radical Treatment of Colorectal Cancer

Journal of the Korean Society of Coloproctology ◽

10.3393/jksc.2008.24.5.373 ◽

2008 ◽

Vol 24 (5) ◽

pp. 373 ◽

Cited By ~ 7

Author(s):

Gil Jae Lee ◽

Jung Nam Lee ◽

Jae Hwan Oh ◽

Jeong-Heum Baek

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Radical Treatment ◽

Mid Term Results

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Short-term clinical outcomes from a randomized controlled trial to evaluate laparoscopic and open surgery for stage II-III colorectal cancer: Japan Clinical Oncology Group study JCOG 0404 (NCT00147134).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.538 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 538-538

Author(s):

Seiichiro Yamamoto ◽

Masafumi Inomata ◽

Seigo Kitano ◽

Hiroshi Katayama ◽

Junki Mizusawa ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Controlled Trial ◽

Short Term ◽

Primary Analysis ◽

Eligibility Criteria ◽

Minimization Method ◽

Term Survival

538 Background: The benefits of laparoscopic surgery (LAP) in comparison with open surgery (OP) have been suggested; however, the long-term survival after LAP for advanced colorectal cancer (CRC) requiring complete mesocolic excision is still unclear. We conducted a study to confirm the non-inferiority of LAP to OP in terms of overall survival with less frequent post-operative morbidity. The primary analysis is planned in 2014, and short-term outcomes including post-operative complications are presented here. Methods: Only accredited surgeons from 30 Japanese institutions participated. Eligibility criteria included histologically proven CRC; tumor located in the cecum, ascending, sigmoid or rectosigmoid colon; T3 or deeper lesion without involvement of other organs; N0–2 and M0; tumor size =<8 cm; patient age 20-75 years. Patients were randomized preoperatively by the minimization method. Patients with pathological stage III received adjuvant chemotherapy with fluorouracil plus leucovorin. The primary endpoint is overall survival, and the planned sample size was 1050. Results: A total of 1057 patients were randomized (OP: 528, LAP: 529) between October 2004 and March 2009. Patients assigned to LAP had less blood loss than those assigned to OP (median 30 ml vs 85 ml, p<0.001), although LAP lasted 52 minutes longer than OP (p<0.001). Radicality of resection, as assessed by the number of resected lymph nodes, did not differ between the two groups. LAP was associated with earlier recovery of bowel function (p<0.001), and with a shorter hospital stay (p<0.0001) than OP. Morbidity and mortality until discharge did not differ between the two groups, except for fewer wound-related complications in LAP (p=0.007). Conclusions: Short-term clinical benefits of LAP were demonstrated, and laparoscopic surgery for advanced CRC can be performed safely by experienced surgeons. If the non-inferiority of LAP in overall survival is demonstrated in the primary analysis planned in 2014, LAP will be the new standard surgical procedure for CRC.

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A COMPARATIVE ANALYSIS OF CLINICALAND PATHOLOGICAL OUTCOME FOLLOWING LAPAROSCOPIC VERSUS OPEN RESECTION IN COLORECTAL CANCER IN A TERTIARY CARE CENTRE IN EASTERN INDIA

10.36106/ijsr/3703547 ◽

2021 ◽

pp. 12-17

Author(s):

Rishin Dutta ◽

Makhan Lal Saha ◽

Chhanda Datta ◽

Diptendra Kumar Sarkar ◽

Soumen Das ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Tertiary Care ◽

Operating Time ◽

Laparoscopic Group ◽

Open Group ◽

Tertiary Care Centre ◽

Colorectal Cancer Surgery ◽

Female Ratio

Background: Colorectal cancer surgery has undergone a continuous evolution of techniques and technologies with the aim of improving oncological outcome and the quality of life. Methods: Using a computer-based randomization patients were divided into two groups. One group underwent laparoscopic surgery (n=20) while the other open surgery (n=20). Results: rd th th th Most common age group affected was in the 3 and 4 decade of life followed by the 5 and 6 decade with a male: female ratio of 1.1:1. The mean operating time was longer in laparoscopic group (218.0±28 mins vs. 191±25 mins in open group) but the intra-operative blood loss was signicantly less in the laparoscopic group (46.2±8 ml) than the open group (107±11 ml). Post-operative complications like wound infection were signicantly lower in the laparoscopic group (zero patient vs. six patients in open group). Conclusion: With proper training and expertise laparoscopic surgery is advantageous over open surgery in colorectal malignancies.

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