Long-term oncological outcomes in patients undergoing laparoscopic versus open surgery for colon cancer: A nationwide cohort study

Aim: To estimate the effect of laparoscopy versus laparotomy on recurrence status in patients undergoing intended curative resection for stage I–III colon cancer using nationwide data. Method: A retrospective cohort study using prospectively collected nationwide quality assurance data on all patients undergoing elective, intended curative surgery for UICC stage I–III colon cancer in Denmark from 1 January 2010, through 31 December 2013. The association between laparoscopic versus open surgery and recurrence status was investigated using cause-specific hazard and subdistribution hazard models with death from any cause as a competing event. Results: In total, 4369 patients undergoing elective intended curative surgery for colon cancer were included in the analysis. Overall, 3243 (74.2%) patients underwent laparoscopic surgery. During a median follow-up time of 84 months, 1191 (27.2%) patients experienced recurrence, and 1304 (29.8%) patients died. The cause-specific hazard of recurrence following laparoscopic versus open surgery was HR_CS = 1.08, 95% CI: 0.90–1.28, p = 0.422. The subdistribution hazard of recurrence following laparoscopic versus open surgery was HR_SD=0.99, 95% CI: 0.84–1.16, p = 0.880. Conclusion: Elective laparoscopic resection for UICC stage I–III colon cancer is oncologically safe and comparable with open resection. These results confirm the external validity of previous RCTs in everyday clinical settings.