Is Minimally Invasive Colon Resection Better Than Traditional Approaches? First Comprehensive National Examination With Propensity Score Matching | Colorectal Cancer | JAMA Surgery | JAMA Network
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1.
Robinson  CN, Chen  GJ, Balentine  CJ,  et al.  Minimally invasive surgery is underutilized for colon cancer.  Ann Surg Oncol. 2011;18(5):1412-1418.PubMedGoogle ScholarCrossref
2.
Alkhamesi  NA, Martin  J, Schlachta  CM.  Cost-efficiency of laparoscopic versus open colon surgery in a tertiary care center.  Surg Endosc. 2011;25(11):3597-3604.PubMedGoogle ScholarCrossref
3.
Lai  JH, Law  WL.  Laparoscopic surgery for colorectal cancer.  Br Med Bull. 2012;104:61-89.PubMedGoogle ScholarCrossref
4.
Weeks  JC, Nelson  H, Gelber  S, Sargent  D, Schroeder  G; Clinical Outcomes of Surgical Therapy (COST) Study Group.  Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial.  JAMA. 2002;287(3):321-328.PubMedGoogle ScholarCrossref
5.
 Laparoscopically assisted colectomy is as safe and effective as open colectomy in people with colon cancer: abstracted from: Nelson H, Sargent D, Wieand HS, et al; for the Clinical Outcomes of Surgical Therapy Study Group: a comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050-2059.  Cancer Treat Rev. 2004;30(8):707-709. PubMedGoogle ScholarCrossref
6.
Delaney  CP, Lynch  AC, Senagore  AJ, Fazio  VW.  Comparison of robotically performed and traditional laparoscopic colorectal surgery.  Dis Colon Rectum. 2003;46(12):1633-1639.PubMedGoogle ScholarCrossref
7.
Braga  M, Vignali  A, Zuliani  W,  et al.  Training period in laparoscopic colorectal surgery.  Surg Endosc. 2002;16(1):31-35.PubMedGoogle ScholarCrossref
8.
Ballantyne  GH.  Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results.  Surg Endosc. 2002;16(10):1389-1402.PubMedGoogle ScholarCrossref
9.
Weber  PA, Merola  S, Wasielewski  A, Ballantyne  GH.  Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease.  Dis Colon Rectum. 2002;45(12):1689-1694; discussion 1695-1696. PubMedGoogle ScholarCrossref
10.
Huettner  F, Dynda  D, Ryan  M, Doubet  J, Crawford  DL.  Robotic-assisted minimally invasive surgery: a useful tool in resident training: the Peoria experience, 2002-2009.  Int J Med Robot. 2010;6(4):386-393.PubMedGoogle ScholarCrossref
11.
Anderson  JE, Chang  DC, Parsons  JK, Talamini  MA.  The first national examination of outcomes and trends in robotic surgery in the United States.  J Am Coll Surg. 2012;215(1):107-114, discussion 114-116.PubMedGoogle ScholarCrossref
12.
Pigazzi  A, Garcia-Aguilar  J.  Robotic colorectal surgery: for whom and for what?  Dis Colon Rectum. 2010;53(7):969-970.PubMedGoogle ScholarCrossref
13.
Pigazzi  A, Luca  F, Patriti  A,  et al.  Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer.  Ann Surg Oncol. 2010;17(6):1614-1620.PubMedGoogle ScholarCrossref
14.
Baik  SH, Kwon  HY, Kim  JS,  et al.  Robotic versus laparoscopic low anterior resection of rectal cancer: short-term outcome of a prospective comparative study.  Ann Surg Oncol. 2009;16(6):1480-1487.PubMedGoogle ScholarCrossref
15.
Bao  Y, Jiang  ZW, Xie  LF, Liu  FT, Li  JS.  Robotic-assisted laparoscopic colectomy for colon cancer: a report of 13 cases [in Chinese].  Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14(5):327-329. PubMedGoogle Scholar
16.
Zimmern  A, Prasad  L, Desouza  A, Marecik  S, Park  J, Abcarian  H.  Robotic colon and rectal surgery: a series of 131 cases.  World J Surg. 2010;34(8):1954-1958.PubMedGoogle ScholarCrossref
17.
Buchs  NC, Pugin  F, Bucher  P, Morel  P.  Totally robotic right colectomy: a preliminary case series and an overview of the literature [published online June 15, 2011].  Int J Med Robot. doi:10.1002/rcs.404. PubMedGoogle Scholar
18.
Huettner  F, Pacheco  PE, Doubet  JL, Ryan  MJ, Dynda  DI, Crawford  DL.  One hundred and two consecutive robotic-assisted minimally invasive colectomies: an outcome and technical update.  J Gastrointest Surg. 2011;15(7):1195-1204.PubMedGoogle ScholarCrossref
19.
D’Annibale  A, Pernazza  G, Morpurgo  E,  et al.  Robotic right colon resection: evaluation of first 50 consecutive cases for malignant disease.  Ann Surg Oncol. 2010;17(11):2856-2862.PubMedGoogle ScholarCrossref
20.
Deutsch  GB, Sathyanarayana  SA, Gunabushanam  V,  et al.  Robotic vs. laparoscopic colorectal surgery: an institutional experience.  Surg Endosc. 2012;26(4):956-963.PubMedGoogle ScholarCrossref
21.
Shin  JY.  Comparison of short-term surgical outcomes between a robotic colectomy and a laparoscopic colectomy during early experience.  J Korean Soc Coloproctol. 2012;28(1):19-26. PubMedGoogle ScholarCrossref
22.
deSouza  AL, Prasad  LM, Park  JJ, Marecik  SJ, Blumetti  J, Abcarian  H.  Robotic assistance in right hemicolectomy: is there a role?  Dis Colon Rectum. 2010;53(7):1000-1006.PubMedGoogle ScholarCrossref
23.
Charlson  ME, Pompei  P, Ales  KL, MacKenzie  CR.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.  J Chronic Dis. 1987;40(5):373-383.PubMedGoogle ScholarCrossref
24.
Finkler  SA.  The distinction between cost and charges.  Ann Intern Med. 1982;96(1):102-109.PubMedGoogle ScholarCrossref
25.
Iezzoni  LI, Daley  J, Heeren  T,  et al.  Identifying complications of care using administrative data.  Med Care. 1994;32(7):700-715.PubMedGoogle ScholarCrossref
26.
Rassen  JA, Shelat  AA, Myers  J, Glynn  RJ, Rothman  KJ, Schneeweiss  S.  One-to-many propensity score matching in cohort studies.  Pharmacoepidemiol Drug Saf. 2012;21(suppl 2):69-80.PubMedGoogle ScholarCrossref
27.
Austin  PC.  Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score.  Am J Epidemiol. 2010;172(9):1092-1097.PubMedGoogle ScholarCrossref
28.
Jacobs  M, Verdeja  JC, Goldstein  HS.  Minimally invasive colon resection (laparoscopic colectomy).  Surg Laparosc Endosc. 1991;1(3):144-150.PubMedGoogle Scholar
29.
Stucky  CC, Pockaj  BA, Novotny  PJ,  et al.  Long-term follow-up and individual item analysis of quality of life assessments related to laparoscopic-assisted colectomy in the COST trial 93-46-53 (INT 0146).  Ann Surg Oncol. 2011;18(9):2422-2431.PubMedGoogle ScholarCrossref
30.
Masoomi  H, Buchberg  B, Nguyen  B, Tung  V, Stamos  MJ, Mills  S.  Outcomes of laparoscopic versus open colectomy in elective surgery for diverticulitis.  World J Surg. 2011;35(9):2143-2148.PubMedGoogle ScholarCrossref
31.
Vaid  S, Tucker  J, Bell  T, Grim  R, Ahuja  V.  Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: results from a large nationwide population database.  Am Surg. 2012;78(6):635-641.PubMedGoogle Scholar
32.
Reissman  P, Cohen  S, Weiss  EG, Wexner  SD.  Laparoscopic colorectal surgery: ascending the learning curve.  World J Surg. 1996;20(3):277-281; discussion 282.PubMedGoogle ScholarCrossref
33.
Schlachta  CM, Mamazza  J, Seshadri  PA, Cadeddu  M, Gregoire  R, Poulin  EC.  Defining a learning curve for laparoscopic colorectal resections.  Dis Colon Rectum. 2001;44(2):217-222.PubMedGoogle ScholarCrossref
34.
Miskovic  D, Ni  M, Wyles  SM, Tekkis  P, Hanna  GB.  Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases.  Dis Colon Rectum. 2012;55(12):1300-1310.PubMedGoogle ScholarCrossref
35.
Rawlings  AL, Woodland  JH, Vegunta  RK, Crawford  DL.  Robotic versus laparoscopic colectomy.  Surg Endosc. 2007;21(10):1701-1708.PubMedGoogle ScholarCrossref
36.
Park  JS, Choi  GS, Park  SY, Kim  HJ, Ryuk  JP.  Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy.  Br J Surg. 2012;99(9):1219-1226.PubMedGoogle ScholarCrossref
37.
Sukumar  S, Sun  M, Karakiewicz  PI,  et al.  National trends and disparities in the use of minimally invasive adult pyeloplasty.  J Urol. 2012;188(3):913-918.PubMedGoogle ScholarCrossref
38.
Garcia-Ellin  JC.  Areas of Hispanic concentration: a differentiation of urban subareas in forty US counties.  Res Contemp Appl Geography. 2000;24(4):1-23.Google Scholar
39.
Hofer  MD, Meeks  JJ, Cashy  J, Kundu  S, Zhao  LC.  Impact of increasing prevalence of minimally invasive prostatectomy on open prostatectomy observed in the national inpatient sample and national surgical quality improvement program.  J Endourol. 2013;27(1):102-107.PubMedGoogle ScholarCrossref
40.
Holzman  MD, Eubanks  S.  Laparoscopic colectomy: prospects and problems.  Gastrointest Endosc Clin N Am. 1997;7(3):525-539.PubMedGoogle Scholar
41.
Hohenberger  W, Schneider  C, Reymond  MA, Scheidbach  H, Köckerling  F.  Laparoscopic resection of colorectal malignancy: an oncological risk? [in German].  Zentralbl Chir. 1997;122(12):1127-1133.PubMedGoogle Scholar
42.
Berman  IR.  Laparoscopic resection for colon cancer: cause for pause.  Important Adv Oncol. 1996:231-243.PubMedGoogle Scholar
43.
Bertagnolli  MM, DeCosse  JJ.  Laparoscopic colon resection for cancer: an unfavorable view.  Adv Surg. 1996;29:155-164.PubMedGoogle Scholar
44.
Park  SY, Choi  GS, Park  JS, Kim  HJ, Choi  WH, Ryuk  JP.  Robot-assisted right colectomy with lymphadenectomy and intracorporeal anastomosis for colon cancer: technical considerations.  Surg Laparosc Endosc Percutan Tech. 2012;22(5):e271-e276.PubMedGoogle ScholarCrossref
45.
Koh  DC, Tsang  CB, Kim  SH.  A new application of the four-arm standard da Vinci surgical system: totally robotic-assisted left-sided colon or rectal resection.  Surg Endosc. 2011;25(6):1945-1952.PubMedGoogle ScholarCrossref
Original Investigation
February 2014

Is Minimally Invasive Colon Resection Better Than Traditional Approaches?First Comprehensive National Examination With Propensity Score Matching

Author Affiliations
  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Surg. 2014;149(2):177-184. doi:10.1001/jamasurg.2013.3660
Abstract

Importance  Minimally invasive colectomies are increasingly popular options for colon resection.

Objective  To compare the perioperative outcomes and costs of robot-assisted colectomy (RC), laparoscopic colectomy (LC), and open colectomy (OC).

Design, Setting, and Participants  The US Nationwide Inpatient Sample database was used to examine outcomes and costs before and after propensity score matching across the 3 surgical approaches. This study involved a sample of US hospital discharges from 2008 to 2010 and all patients 21 years of age or older who underwent elective colectomy.

Main Outcomes and Measures  In-hospital mortality, complications, ostomy rates, conversion to open procedure, length of stay, discharge disposition, and cost.

Results  Of the 244 129 colectomies performed during the study period, 126 284 (51.7%) were OCs, 116 261 (47.6%) were LCs, and 1584 (0.6%) were RCs. In comparison with OC, LC was associated with a lower mortality rate (0.4% vs 2.0%), lower complication rate (19.8% vs 33.2%), lower ostomy rate (3.5 vs 13.0%), shorter median length of stay (4 vs 6 days), a higher routine discharge rate (86.1% vs 68.4%), and lower overall cost than OC ($11 742 vs $13 666) (all P < .05). Comparison between RC and LC showed no significant differences with respect to in-hospital mortality (0.0% vs 0.7%), complication rates (14.7% vs 18.5%), ostomy rates (3.0% vs 5.1%), conversions to open procedure (5.7% vs 9.9%), and routine discharge rates (88.7% vs 88.5%) (all P > .05). However, RC incurred a higher overall hospitalization cost than LC ($14 847 vs $11 966, P < .001).

Conclusions and Relevance  In this nationwide comparison of minimally invasive approaches for colon resection, LC demonstrated favorable clinical outcomes and lower cost than OC. Robot-assisted colectomy was equivalent in most clinical outcomes to LC but incurred a higher cost.

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