Aim

To estimate the effect of laparoscopy vs. 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 January 1, 2010, through December 31, 2013. The association between laparoscopic vs. 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 vs. open surgery was HRCS=1.08, 95% CI: 0.90 to 1.28, p=0.422. The subdistribution hazard of recurrence following laparoscopic vs. open surgery was HRSD=0.99, 95% CI: 0.84 to 1.16, p=0.880.

Conclusion

Elective laparoscopic resection for UICC stage I-III colon cancer was oncologically safe and comparable with open resection. These results confirm the external validity of previous RCTs in everyday clinical settings.