Results from randomized controlled trials and single institutions studies tend to reflect the surgical expertise available at specialized centres.
It can be technically challenging to perform laparoscopically for T4 tumours although recent meta-analyses and register studies have indicated that LAP is safe and possibly even superior with regard to oncological outcomes when compared to OPEN even for T4 tumours 10, 11, 12.įurthermore, one fourth of patients presenting with colon cancer have stage IV cancer at time of diagnosis and the role for laparoscopic surgery for this group remains undetermined. Regardless of the approach, the resection must follow essential oncological principles including central ligation of the primary vessel, proper mesocolic excision, an adequate resection margin and a surgical specimen containing a minimum of 12 lymph nodes 5, 6, 7, 8, 9. International studies including randomized controlled trials have demonstrated less blood loss, reduced pain, shorter length of hospital stay along with improved quality of life during the first postoperative month 1, 4. Surgery is the mainstay of treatment for colon cancer and since the introduction of laparoscopic surgery for colon cancer in the early 1990s, the technique has been proven oncologically safe with the advantage of enhanced recovery 1, 2, 3. Therefore, the favourable short-term outcomes following elective LAP versus OPEN resection for colon cancer in routine health care indicate an advantage of laparoscopic surgery. R1 resections were significantly more common in the OPEN group in the unweighted and weighted analysis with P = 0.004 and P < 0.001 respectively.
Re-operations and re-admission were more frequent after OPEN and length of hospital stay was 2.9 days shorter following LAP ( P < 0.001). The weighted analyses showed an increased 90-day mortality following OPEN, P < 0.001. Weighted and unweighted multi regression analyses were performed. Secondary outcomes were 90-day mortality, length of hospital stay, reoperation, readmission and positive resection margin (R1). All 13,683 patients who were diagnosed 2012–2018 and underwent elective surgery for right-sided or sigmoid colon cancer were included from the Swedish Colorectal Cancer Registry and the National Patient Registry. The aim of this study was to compare LAP with OPEN regarding short-term mortality, morbidity and completeness of the cancer resection for colon cancer in a routine health care setting using population based register data.
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