Trends in laparoscopic colorectal tumour resections across England between 1998 and 2006


Year:

Session type:

Thomas Clarke, Phil Quirke, David Forman, James Thomas, Eva Morris

University of Leeds, UK

Abstract

Proffered paper presentation

Background
In recent years evidence has arisen to demonstrate that open and laparoscopic resections of colorectal cancer produce equivalent outcomes and policy has changed to encourage the laparoscopic approach. This study aimed to investigate patterns and outcomes of laparoscopic resections for colorectal cancer across the English NHS.

Methods
Information on all patients who underwent a major resection for colorectal cancer between 1998 and 2006 were extracted from the National Cancer Data Repository. Analyses were undertaken to determine the frequency of use of laparoscopic surgery across the country and the patient characteristics (age, sex, socioeconomic status, tumour stage) that affected the likelihood of receiving laparoscopic surgery. 30-day operative mortality and duration of hospital stay of patients receiving open and laparoscopic surgery were also compared.

Findings
Of 160,817 major colorectal cancer resections performed between 1998 and 2006, 3460 (2.2%) were performed laparoscopically. Over time there was a significant increase in the number of laparoscopic operations being performed with numbers rising from 98 (0.6%) in 1998 to 1459 (7.8%) in 2006 (P<0.001). Multivariate analysis indicated women were more likely to receive laparoscopic surgery than men (OR: 1.26, 95%CI 1.17 - 1.36, P< 0.001), whilst patients with rectal tumours (OR: 0.68, 95%CI 0.62 - 0.75, P<0.001), advanced Dukes stages (Dukes D: OR: 0.49, 95%CI 0.41 - 0.59, P<0.001) and comorbidities (OR 0.88, 95%CI 0.79 - 0.99, P<0.001) were less likely to be treated laparoscopically. Patients receiving laparoscopic surgery were less likely to die within 30 days of the operation (OR: 0.71, 95%CI 0.59 - 0.88, P<0.001) and had shorter hospital stays (P<0.001).

Conclusion
Over the study period there was a significant increase in the use of laparoscopic surgery across the English NHS. Results suggest laparoscopic surgery is used more frequently on low-risk patients. This may explain the lower 30-day mortality and shorter hospital stays observed for patients treated laparoscopically.