a Division of Clinical Chinese Medicine , National Research Institute of Chinese Medicine , Ministry of Health and Welfare , Taipei , Taiwan.
b Institute of Health Policy and Management , College of Public Health , National Taiwan University , Taipei , Taiwan.
Curr Med Res Opin. 2018 Sep;34(9):1663-1671. doi: 10.1080/03007995.2018.1484713. Epub 2018 Jun 27.
Laparoscopy is a safe and effective treatment for colon cancer. However, its effects on short- and long-term health outcomes and medical utilization are not fully elucidated. This study aimed to compare short- and long-term utilization and health outcomes of colon cancer patients who underwent either laparoscopic or open surgery in a population-based cohort.
This study was conducted by linking data from Taiwan Cancer Registry, National Health Insurance claims and Death Registry. Patients aged 18 and older with colon cancer between 2009 and 2012 were included in the study. Propensity score matching was used to minimize selection bias between laparoscopic and open surgery groups. Cox proportional hazard regression and generalized linear mixed logistic regression were used to test hypotheses.
Among the 11,269 colon cancer patients who underwent colectomy, 3236 (28.72%) received laparoscopy and 8033 (71.28%) underwent open surgery. Patients who received laparoscopic surgery had better overall survival (HR = 0.82; 95% CI: 0.70-0.97). These patients also had lower 30 day mortality (0.44% vs. 0.91%), lower 1 year mortality (2.83% vs. 4.68%), lower overall occurrence of complications (6.16% vs. 8.77%), shorter mean length of stay (12.53 vs. 14.93 days) and lower cost for index hospitalization (US$4325.34 vs. US$4453.90). No significant differences were observed in medical utilization over a period of 365 days after the surgery.
Our results demonstrate that, in both the short- and long-term post-operation periods, laparoscopic surgery reduced the likelihood of postoperative complications, 30 day, and 1 year mortality while being no more expensive than open surgery for colon cancer.
腹腔镜手术是治疗结肠癌的一种安全有效的方法。然而，其对短期和长期健康结果和医疗利用的影响尚未完全阐明。本研究旨在比较腹腔镜和开放手术治疗结肠癌患者的短期和长期利用和健康结果的人群队列研究。
本研究通过链接来自台湾癌症登记处、全民健康保险理赔和死亡登记处的数据进行。纳入 2009 年至 2012 年间患有结肠癌且年龄在 18 岁及以上的患者。采用倾向评分匹配法最小化腹腔镜和开放手术组之间的选择偏差。采用 Cox 比例风险回归和广义线性混合逻辑回归检验假设。
在接受结直肠切除术的 11269 例结肠癌患者中，3236 例（28.72%）接受了腹腔镜手术，8033 例（71.28%）接受了开放手术。接受腹腔镜手术的患者总生存率更好（HR=0.82；95%CI：0.70-0.97）。这些患者的 30 天死亡率也较低（0.44% vs. 0.91%），1 年死亡率较低（2.83% vs. 4.68%），总体并发症发生率较低（6.16% vs. 8.77%），平均住院时间较短（12.53 天 vs. 14.93 天），指数住院费用较低（4325.34 美元 vs. 4453.90 美元）。手术后 365 天内的医疗利用情况没有显著差异。
我们的结果表明，在手术的短期和长期后期间，腹腔镜手术降低了术后并发症、30 天和 1 年死亡率的可能性，同时与开放手术相比，腹腔镜手术治疗结肠癌的费用并不高。
