Yeo Heather, Niland Joyce, Milne Dana, ter Veer Anna, Bekaii-Saab Tanios, Farma Jeffrey M, Lai Lily, Skibber John M, Small William, Wilkinson Neal, Schrag Deborah, Weiser Martin R
Memorial Sloan Kettering Cancer Center, New York, NY (HY, MRW); City of Hope Comprehensive Cancer Center, Duarte, CA (JN, AtV, LL, DS); Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (DM, LL); The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, OH (TBS); Fox Chase Cancer Center, Philadelphia, PA (JMF); The University of Texas M.D. Anderson Cancer Center, Houston, TX (JMS); Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL (WS Jr); Roswell Park Cancer Institute, Buffalo, NY (NW).
J Natl Cancer Inst. 2014 Dec 19;107(1):362. doi: 10.1093/jnci/dju362. Print 2015 Jan.
Laparoscopic colectomy has been shown to have equivalent oncologic outcomes to open colectomy for the management of colon cancer, but its adoption nationally has been slow. This study investigates the prevalence and factors associated with laparoscopic colorectal resection at National Comprehensive Cancer Network (NCCN) centers.
Data on patients undergoing surgery for colon and rectal cancer at NCCN centers from 2005 to 2010 were obtained from chart review of medical records for the NCCN Outcomes Project and included information on socioeconomic status, insurance coverage, comorbidity, and physician-reported Eastern Cooperative Oncology Group (ECOG) performance status. Associations between receipt of minimally invasive surgery and patient and clinical variables were analyzed with univariate and multivariable logistic regression. All statistical tests were two-sided.
A total of 4032 patients, diagnosed between September 2005 and December 2010, underwent elective colon or rectal resection for cancer at NCCN centers. Median age of colon cancer patients was 62.6 years, and 49% were men. The percent of colon cancer patients treated with minimally invasive surgery (MIS) increased from 35% in 2006 to 51% in 2010 across all centers but varied statistically significantly between centers. On multivariable analysis, factors associated with minimally invasive surgery for colon cancer patients who had surgery at an NCCN institution were older age (P = .02), male sex (P = .006), fewer comorbidities (P ≤ .001), lower final T-stage (P < .001), median household income greater than or equal to $80000 (P < .001), ECOG performance status = 0 (P = .02), and NCCN institution (P ≤ .001).
The use of MIS increased at NCCN centers. However, there was statistically significant variation in adoption of MIS technique among centers.
对于结肠癌的治疗，腹腔镜结肠切除术已被证明与开腹结肠切除术具有相同的肿瘤学疗效，但在全国范围内其采用率一直较低。本研究调查了美国国立综合癌症网络（NCCN）中心腹腔镜大肠切除术的普及率及相关因素。
通过对NCCN疗效项目的病历进行图表回顾，获取2005年至2010年在NCCN中心接受结肠癌和直肠癌手术患者的数据，包括社会经济状况、保险覆盖情况、合并症以及医生报告的东部肿瘤协作组（ECOG）体能状态信息。采用单因素和多因素逻辑回归分析微创手术的接受情况与患者及临床变量之间的关联。所有统计检验均为双侧检验。
共有4032例在2005年9月至2010年12月期间被诊断为结肠癌或直肠癌的患者在NCCN中心接受了择期手术。结肠癌患者的中位年龄为62.6岁，49%为男性。所有中心接受微创手术（MIS）治疗的结肠癌患者比例从2006年的35%增至2010年的51%，但各中心之间存在显著的统计学差异。多因素分析显示，在NCCN机构接受手术的结肠癌患者中，与微创手术相关的因素包括年龄较大（P = 0.02）、男性（P = 0.006）、合并症较少（P≤0.001）、最终T分期较低（P < 0.001）、家庭收入中位数大于或等于80000美元（P < 0.001）、ECOG体能状态为0（P = 0.02）以及NCCN机构（P≤0.001）。
NCCN中心对MIS的使用有所增加。然而，各中心在MIS技术的采用上存在显著的统计学差异。
