OBJECTIVES:  Previous randomized trials and observational studies have shown only comparable survival benefits for colon cancer patients undergoing colectomy with laparoscopic versus conventional open surgery. Although laparoscopic surgery has become a preferred approach, its survival benefits have not been adequately examined in a recent colon cancer cohort. We therefore assessed in a real-world Medicare population short- and long-term survival among early-stage colon cancer patients treated with laparoscopic-assisted colectomy (LAC) versus open colectomy (OC).

METHODS:  In this retrospective observational cohort study, early-stage colon cancer patients aged ≥65 years who received colectomy within 6 months of diagnosis were selected from the SEER-Medicare database (2004-2010). Patients undergoing LAC were propensity-matched to those receiving OC on demographic and clinical characteristics (stage at diagnosis, tumor size, and comorbidities). Short-term (1-year) and long-term (5-year) overall survival rates and survival times were assessed using Kaplan-Meier methods for the overall cohort and separately by stage at diagnosis (local versus regional).

RESULTS:  A total of 11,230 early-stage cancer patients met the study inclusion criteria (55% female; median age 78 years). Of total, a majority (58.8%) were diagnosed with local stage cancer. The 1-year survival was significantly higher in the LAC (vs. OC) group for the overall cohort (90.7% vs. 84.6%; p<0.001), local stage (92.6% vs. 88.4%; p<0.001), and regional stage (87.9% vs. 79.4%; p<0.001). The 5-year survival was much lower but significantly better in the LAC group for the overall cohort (65.7% vs. 58.0%; p<0.001), local stage (71.2% vs. 65.5%; p<0.001) and regional stage (57.5% vs. 47.7%; p<0.001). Regional-stage patients treated with LAC had longer median survival time (6.4 vs. 4.6 years; p<0.001).

CONCLUSIONS:  Results of this study indicate that LAC was associated with greater short- and long-term overall survival rates and survival times versus OC among elderly early-stage colon cancer patients, particularly those with regional-stage disease at diagnosis.