講演情報
[ESCP]A Comprehensive NCDB Analysis on Practice Trends and Outcomes of Right Colectomy for Colon Cancer in the United States
Zoe Garoufalia1, Sameh Hany Emile1,2, Nir Horesh1,3, Ashley Shustak1, Marcus Oosenbrug1, Ebram Salama1, Rachel Gefen1,4, Marylise Boutros1, Steven D. Wexner1 (1.Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA, 2.Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Affiliated with the Faculty of Medicine, Tel Aviv University, Israel, 3.Colorectal Surgery Unit, Mansoura University, Faculty of Medicine, Egypt, 4.Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel)
Purpose/Background
Right-sided colon cancer has been reported to have worse survival and recurrence rates than left-sided or rectal cancer. This could be due to different biology, non-standardized surgical treatment, or less use of neoadjuvant/adjuvant therapy. The aim of this study was to assess the oncological outcomes of right colectomy for colon cancer and to explore the treatment trends in the USA over a 15-year period.
Methods/Interventions
Retrospective analysis of the National Cancer Database 2005-2019（NCDB）. The cohort was divided into 3 periods：2005-2009（1）；2010-2014（2）, and 2015-2019（3）. The three periods were compared with regards to patient and tumor characteristics, treatments, and outcomes. Crude statistical analysis was performed using EZR（version 1.55）software.
Results/Outcomes
From 2005-2019, 312884 patients（54.5％ female）with a mean age of 70（SD：12.5）years underwent hemicolectomy for right colon cancer.
Periods 1, 2, and 3 included 104265, 103053, and 105566 patients, respectively. A significant increase in the rates of laparoscopic surgery（45.6％ to 53.4％）and robotic surgery（3％ to 12.9％）was noted over time, while the rates of open surgery decreased（51.4％ to 33.7％）. The median number of harvested LNs significantly increased over the years from 17 to 20.
The use of chemotherapy significantly increased over time（15.6％ to 20.9％）. Neoadjuvant chemotherapy was significantly more often used in period 3（0.6％ to 1.2％）while the use of adjuvant therapy remained stable（31.4％ to 32.1％）. A significant increase was noted in the median time from diagnosis to surgery, doubling in length in Period 3 compared to Period 1（14 vs. 7 days）.
A significant increase was noted in surgical treatment of metastatic right colon cancer over time（18.3％ to 30％）. Thirty day and 90-day mortality decreased over time from 4.1％ to 3％ and from 7.6％ to 5.5％ respectively.
Overall survival（OS）significantly（p＜0.001）increased from a mean of 72.3 months（95％ CI：72.1-72.7）in period 1 to 77.4 months（95％ CI：75.2-79.8）in Period 3.
Conclusion/Discussion
Colectomy for right colon cancer, although considered a“simple”operation, remains associated with a mean OS of 6 years；and this OS has increased by 5 months over the study period. Further prospective data is required to elucidate potentially modifiable factors in surgical approach or perioperative therapeutic strategies.
Right-sided colon cancer has been reported to have worse survival and recurrence rates than left-sided or rectal cancer. This could be due to different biology, non-standardized surgical treatment, or less use of neoadjuvant/adjuvant therapy. The aim of this study was to assess the oncological outcomes of right colectomy for colon cancer and to explore the treatment trends in the USA over a 15-year period.
Methods/Interventions
Retrospective analysis of the National Cancer Database 2005-2019（NCDB）. The cohort was divided into 3 periods：2005-2009（1）；2010-2014（2）, and 2015-2019（3）. The three periods were compared with regards to patient and tumor characteristics, treatments, and outcomes. Crude statistical analysis was performed using EZR（version 1.55）software.
Results/Outcomes
From 2005-2019, 312884 patients（54.5％ female）with a mean age of 70（SD：12.5）years underwent hemicolectomy for right colon cancer.
Periods 1, 2, and 3 included 104265, 103053, and 105566 patients, respectively. A significant increase in the rates of laparoscopic surgery（45.6％ to 53.4％）and robotic surgery（3％ to 12.9％）was noted over time, while the rates of open surgery decreased（51.4％ to 33.7％）. The median number of harvested LNs significantly increased over the years from 17 to 20.
The use of chemotherapy significantly increased over time（15.6％ to 20.9％）. Neoadjuvant chemotherapy was significantly more often used in period 3（0.6％ to 1.2％）while the use of adjuvant therapy remained stable（31.4％ to 32.1％）. A significant increase was noted in the median time from diagnosis to surgery, doubling in length in Period 3 compared to Period 1（14 vs. 7 days）.
A significant increase was noted in surgical treatment of metastatic right colon cancer over time（18.3％ to 30％）. Thirty day and 90-day mortality decreased over time from 4.1％ to 3％ and from 7.6％ to 5.5％ respectively.
Overall survival（OS）significantly（p＜0.001）increased from a mean of 72.3 months（95％ CI：72.1-72.7）in period 1 to 77.4 months（95％ CI：75.2-79.8）in Period 3.
Conclusion/Discussion
Colectomy for right colon cancer, although considered a“simple”operation, remains associated with a mean OS of 6 years；and this OS has increased by 5 months over the study period. Further prospective data is required to elucidate potentially modifiable factors in surgical approach or perioperative therapeutic strategies.