A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study

Aim The oncological risk/benefit trade-off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic vs open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain). Methods This was a multicentre retrospective...

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Autores: Manchon-Walsh, P, Aliste, L, Biondo, S, Espin, E, Pera, M, Targarona, E, Pallares, N, Vernet, R, Espinas, JA, Guarga, A, Borras, JM
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p2766
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2766
http://hdl.handle.net/2445/132844
Access Level:acceso abierto
Palabra clave:Rectal cancer
laparoscopy
population-based
propensity-score analysis
surgery
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spelling A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based studyManchon-Walsh, PAliste, LBiondo, SEspin, EPera, MTargarona, EPallares, NVernet, REspinas, JAGuarga, ABorras, JMRectal cancerlaparoscopypopulation-basedpropensity-score analysissurgeryAim The oncological risk/benefit trade-off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic vs open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain). Methods This was a multicentre retrospective cohort study of all patients who had surgery with curative intent for primary rectal cancer at Catalonian public hospitals from 2011 to 2012. We obtained follow-up data for up to 5 years. To minimize the differences between the two groups, we performed propensity score matching on baseline patient characteristics. We used multivariate Cox proportional hazards regression analyses to assess locoregional relapse at 2 years and death at 2 and 5 years. Results Of 1513 patients with Stage I-III rectal cancer, 933 (61.7%) had laparoscopy (conversion rate 13.2%). After applying our propensity score matching strategy (2:1), 842 laparoscopy patients were matched to 517 open surgery patients. Multivariate Cox analysis of death at 2 years [hazard ratio (HR) 0.65, 95% CI 0.48, 0.87; P = 0.004] and 5 years (HR 0.61, 95% CI 0.5, 0.75; P < 0.001) and of local relapse at 2 years (HR 0.44, 95% CI 0.27, 0.72; P = 0.001) showed laparoscopy to be an independent protective factor compared with open surgery. Conclusions Laparoscopy results in lower locoregional relapse and long-term mortality in rectal cancer in unselected patients with all-risk groups included. Studies using long-term follow-up of cohorts and unselected data can provide information on clinically relevant outcomes to supplement randomized controlled trials.WILEY2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2766http://hdl.handle.net/2445/132844Colorectal DiseaseISSN: 14628910ISSNe: 14631318reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p27662026-06-14T12:41:47Z
dc.title.none.fl_str_mv A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
title A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
spellingShingle A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
Manchon-Walsh, P
Rectal cancer
laparoscopy
population-based
propensity-score analysis
surgery
title_short A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
title_full A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
title_fullStr A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
title_full_unstemmed A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
title_sort A propensity-score-matched analysis of laparoscopic vs open surgery for rectal cancer in a population-based study
dc.creator.none.fl_str_mv Manchon-Walsh, P
Aliste, L
Biondo, S
Espin, E
Pera, M
Targarona, E
Pallares, N
Vernet, R
Espinas, JA
Guarga, A
Borras, JM
author Manchon-Walsh, P
author_facet Manchon-Walsh, P
Aliste, L
Biondo, S
Espin, E
Pera, M
Targarona, E
Pallares, N
Vernet, R
Espinas, JA
Guarga, A
Borras, JM
author_role author
author2 Aliste, L
Biondo, S
Espin, E
Pera, M
Targarona, E
Pallares, N
Vernet, R
Espinas, JA
Guarga, A
Borras, JM
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Rectal cancer
laparoscopy
population-based
propensity-score analysis
surgery
topic Rectal cancer
laparoscopy
population-based
propensity-score analysis
surgery
description Aim The oncological risk/benefit trade-off for laparoscopy in rectal cancer is controversial. Our aim was to compare laparoscopic vs open surgery for resection of rectal cancer, using unselected data from the public healthcare system of Catalonia (Spain). Methods This was a multicentre retrospective cohort study of all patients who had surgery with curative intent for primary rectal cancer at Catalonian public hospitals from 2011 to 2012. We obtained follow-up data for up to 5 years. To minimize the differences between the two groups, we performed propensity score matching on baseline patient characteristics. We used multivariate Cox proportional hazards regression analyses to assess locoregional relapse at 2 years and death at 2 and 5 years. Results Of 1513 patients with Stage I-III rectal cancer, 933 (61.7%) had laparoscopy (conversion rate 13.2%). After applying our propensity score matching strategy (2:1), 842 laparoscopy patients were matched to 517 open surgery patients. Multivariate Cox analysis of death at 2 years [hazard ratio (HR) 0.65, 95% CI 0.48, 0.87; P = 0.004] and 5 years (HR 0.61, 95% CI 0.5, 0.75; P < 0.001) and of local relapse at 2 years (HR 0.44, 95% CI 0.27, 0.72; P = 0.001) showed laparoscopy to be an independent protective factor compared with open surgery. Conclusions Laparoscopy results in lower locoregional relapse and long-term mortality in rectal cancer in unselected patients with all-risk groups included. Studies using long-term follow-up of cohorts and unselected data can provide information on clinically relevant outcomes to supplement randomized controlled trials.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2766
http://hdl.handle.net/2445/132844
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=2766
http://hdl.handle.net/2445/132844
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv Colorectal Disease
ISSN: 14628910
ISSNe: 14631318
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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