Laparoscopic Surgery for Colorectal Cancer in Korea: Nationwide Data from 2008~2013

Laparoscopic and robotic surgery for colorectal cancer in Korea: a nationwide health insurance database analysis from 2019 to 2023

Purpose

This study examined nationwide data regarding laparoscopic and robotic surgery for colorectal cancer (CRC) in Korea.

Methods

Nationwide data concerning patients who underwent surgery for CRC from 2019 to 2023 were obtained from the Health Insurance Review and Assessment Service database.

Results

From 2019 to 2023, a total of 109,573 patients with CRC underwent surgical resection in Korea. Among these, open, laparoscopic, and robotic surgery comprised 17.2%, 71.5%, and 11.3%, respectively. Open surgery decreased from 18.3% in 2019 to 15.2% in 2023, whereas robotic surgery increased from 10.3% in 2019 to 12.7% in 2023. Regarding rectal cancer, the rate of robotic surgery increased from 23.0% in 2019 to 28.2% in 2023, and the rate of minimally invasive surgery (MIS) increased from 86.9% in 2019 to 89.2% in 2023. Patients with National Health Insurance had significantly shorter lengths of hospital stay after surgery than those with medical aid for all surgical methods (p < 0.0001). With respect to hospital size, 74,282 CRC surgeries (67.8%) were performed in tertiary general hospitals and 33,050 (30.2%) in general hospitals. By the region, 47,140 cases (43.0%) were performed in Seoul, 19,961 (18.2%) in Gyeonggi, and 7,417 (6.8%) in Daegu. Ostomy was created in 16,222 CRC surgeries (14.8%).

Conclusion

The rate of MIS adoption for CRC in Korea has increased, reaching 84.7% in 2023. The rate of laparoscopic surgery exceeded 70% and has plateaued. In contrast, the rate of robotic surgery adoption has steadily increased, particularly for rectal cancer, where it surpassed 28% in 2023.

Cost-effectiveness and readmission rates of laparoscopic vs. open surgery for colorectal cancer: evidence from the health insurance review and assessment service dataset in South Korea

Introduction

We aimed to compare and analyze the cost-effectiveness of laparoscopic vs. open colorectal surgery (CRS) for colorectal cancer using health insurance claims data derived from multiple institutions in South Korea as well as the differences in hospital length of stay (LOS) and 30-day readmission rates related to postoperative complications.

Methods

We retrospectively reviewed the clinical data of patients who underwent curative resection for colorectal cancer between January 1, 2020 and December 31, 2022 using national health insurance claims data in South Korea. We determined the surgical approach based on the presence or absence of treatment material codes specific to laparoscopic surgery, and divided the patients into the laparoscopic-CRS (lap-CRS) and open-CRS groups.

Results

A total of 34,779 patients were included [open-CRS: 3,262 patients [9.4%]; lap-CRS: 31,517 patients [90.6%]]. The mean LOS was 14.11 and 11.27 days for the open- and lap-CRS groups, respectively (p < 0.001). The mean medical costs were 9,163 USD and 8,963 USD in the open- and lap-CRS groups, respectively (p < 0.001). A total of 1,192 (3.4%) patients were readmitted within 30 days of discharge, with a rate of 5.4% (176 cases) and 3.2% (1,016 cases) in the open- and lap-CRS groups, respectively (p < 0.001). Open surgery, male sex, and rectal surgery were identified as factors that increased medical cost.

Discussion

According to this South Korean nationwide population-based study, laparoscopic surgery demonstrated a reduction in LOS, medical costs, and readmission rates compared with open surgery in patients with colorectal cancer.

The Usefulness of a 180° Rotatable Monitor for an Assistant to Overcome the Hand-Eye Discordance in Laparoscopic Colorectal Surgery

Purpose

Hand-eye discordance during laparoscopic colon surgery is an obstacle to the assistant. We evaluated the usefulness of a 180° rotatable laparoscopic monitor for the colorectal surgery assistant to overcome hand-eye discordance.

Methods

Twenty-six residents of the department of surgery (novice group, n=13; experienced group, n=13) participated in this study. They performed grasping a ring and transferring it to standing bars on a laparoscopic training kit under the conventional view and a 180° rotated monitor view. We defined successful performance when this procedure was completed in 3 minutes.

Results

The number of successful performance was higher under the 180° rotated monitor view than under the conventional view monitor (6.88±2.79 vs. 0.92±0.80, p<0.01). Under the 180° rotated monitor view, the experienced group had a higher number of successful performances than the novice group (8.31±2.59 vs. 5.46±2.26, p=0.009). However, no statistically significant difference was found between the two groups under the conventional view (1.23±0.93 vs. 0.62±0.51, p=0.091).

Conclusion

This study shows the usefulness of a 180° rotated monitor view to overcome hand-eye discordance, which adversely affects the laparoscopic performance of the colorectal surgery assistant.

Laparoscopic Surgery for Colorectal Cancer in Korea: Nationwide Data from 2013 to 2018

PURPOSE

We report nationwide data on the current status of laparoscopic surgery for colorectal cancer (CRC) in Korea.

Materials and Methods

Nationwide data of patients who underwent surgery for CRC from 2013 to 2018 were obtained from the Health Insurance Review & Assessment Service database. Data and trends of laparoscopy use for colorectal resection over six years were examined.

RESULTS

In Korea, a total of 117,320 patients underwent surgical resection for CRC from 2013 to 2018. The proportion of laparoscopic resection increased from 64.9% in 2013 to 78.5% in 2018. The rate of laparoscopic resection for colon cancer increased from 64.7% in 2013 to 77.4% in 2018. For rectal cancer, the rate of laparoscopic resection increased from 65.4% to 81.6%. Males accounted for 59.8% of all patients, but females surpassed males at over 80 years of age. The age of peak incidence was in the 60s for males and in the 70s for females. A steady increase in the number of patients undergoing surgery for CRC was observed over 80 years of age.

CONCLUSION

The laparoscopic penetration rate for CRC in Korea continued to increase annually and reached 78.5% in 2018.

Comparison of the effects of an ERAS program and a single-port laparoscopic surgery on postoperative outcomes of colon cancer patients

Advancement of the surgical modality and perioperative care are the two main dimensions for the modern improvement of surgical outcome. The purpose of this study was to compare the effectiveness of the two by using the data from the single-port laparoscopic surgery and the early recovery after surgery (ERAS) program. Patients who underwent elective surgery for primary adenocarcinoma of the colon were divided into three groups and compared: ERAS (multi-port laparoscopic surgery with ERAS perioperative care), Conventional-SILS (single-port surgery with conventional perioperative care), or Conventional-Multi (multi-port laparoscopic surgery with conventional perioperative care). Ninety-one, 83, and 96 patients were registered, respectively. There were no differences among the three groups in baseline characteristics except pathological stage and operation site in colon. Although the ERAS group started a soft diet earlier and had earlier discharge, there were no differences in intra- and post-operative morbidity rate, readmission rate, or reoperation rate. The ERAS perioperative care was a significant factor for reducing length of hospital stay in the multivariate analysis, while single-port surgery was not. In modern laparoscopic colon cancer treatment, a systemic approach such as the ERAS program appears to be more effective than a technical approach for significantly improving short-term surgical outcomes.

Inguinal hernia surgery in Korea: nationwide data from 2007-2015

Purpose

The aim of this study is to analyze inguinal hernia in Korea based on the nationwide data.

Methods

Retrospective analysis of nationwide data obtained from the Health Insurance Review & Assessment Service database for surgical repair of inguinal hernia from January, 2007 to December, 2015 was performed.

Results

A total of 314,238 cases of inguinal hernia surgery were performed during 9 years. The mean number of inguinal hernia surgery per year was 34,604 (range, 30,065–36,928). The proportion of male patient was 87%. Patients between the age of 1 to 5 years (17.3%) and of 60 to 69 years (17.4%) constituted the 2 dominant groups for inguinal hernia repair. A slight increase in repair for recurrent inguinal hernia, 1.9% to 3.2%, was observed from 2007 to 2015. The rate of concurrent bowel resection decreased from 1.9% to 0.6%. The total cost of inguinal hernia surgery was increased up to 1.68 times from 2007 to 2015 ($856 to $1,439), although the number of hospital days was decreased from 4.7 to 3.7 days. The rate of laparoscopic surgery was increased to 29.5% in 2015.

Conclusion

A mean number of 34,604 cases of inguinal hernia surgery have been carried out annually in Korea. The age distribution for inguinal hernia repair demonstrates bimodal peak at early childhood and old age. The proportion of laparoscopic surgery of inguinal hernia has been increasing for the past 9 years. The length of hospital stay and the rate of combined bowel resection have decreased.

Comparison of Short-Term Outcomes Between 3D and 2D Imaging Laparoscopic Colectomy with D3 Lymphadenectomy for Colon Cancer

BACKGROUND

Three-dimensional (3D) imaging for laparoscopy was introduced to overcome the limitations of conventional two-dimensional (2D) imaging that lacked depth perception and spatial orientation. This study aimed to evaluate the effect of 3D imaging in laparoscopic colectomy with D3 lymphadenectomy for colon cancer.

METHODS

From February 2014 to October 2016, the prospective database of 278 consecutive patients with colon cancer was analyzed retrospectively; these patients underwent laparoscopic surgery with 2D (n = 111) and 3D (n = 167) imaging, with curative intent.

RESULTS

No difference was found in sex, body mass index, history of abdominal surgery, and American Society of Anesthesiologists grade between the 3D and 2D groups. The estimated blood loss was less in the 3D group than in the 2D group (50 mL [30-100 mL] versus 100 mL [50-100 mL], P < .001). The number of resected lymph nodes was higher in the 3D group (n = 47 [37.5-60] versus 41 [32-51.5], P = .001). However, a difference in operative time was not observed in both groups (150 minutes [125-175 minutes] versus 155 minutes [135-177.5 minutes], P = .186). Postoperative morbidity was similar in both groups (7.8% versus 8.1%, P = 1.000). Time to pass first flatus (3 days [2-4 days] versus 3 days [3-4 days], P = .746) and postoperative hospital stay (6 days [6-8 days] versus 6 days [6-7 days], P = .087) were also similar.

CONCLUSIONS

This study shows that laparoscopic colectomy with D3 lymphadenectomy for colon cancer using 3D laparoscopic systems appears to be beneficial, with less blood loss, which should be addressed in prospective studies.

Uptake of elective laparoscopic colectomy for colon cancer in Canada from 2004/05 to 2014/15: a descriptive analysis

BACKGROUND

Evidence from randomized controlled trials published since 2004 shows that elective laparoscopic colectomy for colon cancer improves short-term postoperative outcomes with equivalent oncologic outcomes compared to open colectomy. The objective of this study was to examine the uptake of elective laparoscopic colectomy in Canada and compare its use among Canadian provinces.

METHODS

In this descriptive analysis, we identified from hospital discharge abstracts all patients in the Canadian provinces (except Quebec) who underwent elective colectomy for colon cancer between 2004/05 and 2014/15. We compared temporal changes in the proportion of patients who underwent laparoscopic colectomy or open colectomy among provinces using logistic regression.

RESULTS

Of 63 504 patients who underwent elective colectomy between 2004/05 and 2014/15, 19 691 (31.0%) underwent laparoscopic colectomy. The annual proportion of patients who underwent laparoscopic colectomy increased from 9.2% in 2004/05 to 51.5% in 2014/15 (mean annual percent increase 4.2%). There were significant differences between provinces in the overall proportion of patients who underwent laparoscopic colectomy (p < 0.001), ranging from 7.6% in Newfoundland and Labrador to 36.9% in Ontario. By 2014/15, most colectomy procedures were performed laparoscopically in 3 provinces; British Columbia (60.2%), Ontario (59.4%) and Alberta (53.1%). In addition to year and province, urban residence, younger age, female sex, fewer medical comorbidities, high surgeon volume, high hospital volume and right-sided tumours were significantly associated with increased likelihood of laparoscopic colectomy.

INTERPRETATION

Although the use of laparoscopic colectomy increased rapidly between 2004/05 and 2014/15 in Canada, substantial interprovincial variation exists. Further knowledge-translation strategies are needed to ensure equal access to laparoscopic colectomy for all Canadians.

Achieving high quality standards in laparoscopic colon resection for cancer: A Delphi consensus-based position paper

AIM

To investigate the rate of laparoscopic colectomies for colon cancer using registries and population-based studies. To provide a position paper on mini-invasive (MIS) colon cancer surgery based on the opinion of experts leader in this field.

METHODS

A systematic review of the literature was conducted using PRISMA guidelines for the rate of laparoscopy in colon cancer. Moreover, Delphi methodology was used to reach consensus among 35 international experts in four study rounds. Consensus was defined as an agreement ≥75.0%. Domains of interest included nosology, essential technical/oncological requirements, outcomes and MIS training.

RESULTS

Forty-four studies from 42 articles were reviewed. Although it is still sub-optimal, the rate of MIS for colon cancer increased over the years and it is currently >50% in Korea, Netherlands, UK and Australia. The remaining European countries are un-investigated and presented lower rates with highest variations, ranging 7-35%. Using Delphi methodology, a laparoscopic colectomy was defined as a "colon resection performed using key-hole surgery independently from the type of anastomosis". The panel defined also the oncological requirements recognized essential for the procedure and agreed that when performed by experienced surgeons, it should be marked as best practice in guidelines, given the principles of oncologic surgery be respected (R0 procedure, vessel ligation and mesocolon integrity).

CONCLUSION

The rate of MIS colectomies for cancer in Europe should be further investigated. A panel of leaders in this field defined laparoscopic colectomy as a best practice procedure when performed by an experienced surgeon respecting the standards of surgical oncology.

Laparoscopic and Robotic Surgeries for Patients With Colorectal Cancer Who Have Had a Previous Abdominal Surgery

PURPOSE

The impact of previous abdominal surgery (PAS) on surgical outcomes from laparoscopic and robot surgeries is inconclusive. This study aimed to investigate the impact of PAS on perioperative outcomes from laparoscopic and robotic colorectal surgeries.

METHODS

From March 2007 to February 2014, a total of 612 and 238 patients underwent laparoscopic and robotic surgeries, respectively. Patients were divided into 3 groups: those who did not have a PAS (NPAS), those who had a major PAS, and those who had a minor PAS. We further divided the patients so that our final groups for analysis were: patients with NPAS (n = 478), major PAS (n = 19), and minor PAS (n = 115) in the laparoscopy group, and patients with NPAS (n = 202) and minor PAS (n = 36) in the robotic surgery group.

RESULTS

In the laparoscopy group, no differences in the conversion rates between the 3 groups were noted (NPAS = 1.0% vs. major PAS = 0% vs. minor PAS = 1.7%, P = 0.701). In the robotic surgery group, the conversion rate did not differ between the NPAS group and the minor PAS group (1.0% vs. 2.8%, P = 0.390). Among the groups, neither the operation time, blood loss, days to soft diet, length of hospital stay, nor complication rate were affected by PAS.

CONCLUSION

PAS did not jeopardize the perioperative outcomes for either laparoscopic or robotic colorectal surgeries. Therefore, PAS should not be regarded as an absolute contraindication for minimally invasive colorectal surgeries.

Laparoscopy may decrease morbidity and length of stay after elective colon cancer resection, especially in frail patients: results from an observational real-life study

BACKGROUND

Advantages of laparoscopic approach in colon cancer surgery have been previously demonstrated in controlled, randomized trials and in retrospective analysis of large administrative databases. Nevertheless, evidence of these advantages in prospective, observational studies from real-life settings is scarce.

METHODS

This is a prospective, observational study, including a consecutive series of patients that underwent elective colonic resection for cancer in 52 Spanish hospitals. Pre-/intraoperative data, related to patient, tumor, surgical procedure, and hospital, were recorded as well as 60-day post-operative outcomes, including wound infection, complications, anastomotic leak, length of stay, and mortality. A univariate and multivariate analysis was performed to determine the influence of laparoscopy on short-term post-operative outcome. A sub-analysis of the effect of laparoscopy according to patients' pre-operative risk (ASA Score I-II vs. III-IV) was also performed.

RESULTS

2968 patients were included: 44.2% were initially operated by laparoscopy, with a 13.9% conversion rate to laparotomy. At univariate analysis, laparoscopy was associated with a decreased mortality (p = 0.015), morbidity (p < 0.0001), wound infection (p < 0.0001), and post-operative length of stay (p < 0.0001). At multivariate analysis, laparoscopy resulted as an independent protective factor for morbidity (OR 0.7; p = 0.004), wound infection (OR 0.6; p < 0.0001), and length of post-operative stay (Effect-2 days; p < 0.0001), compared to open approach. These advantages were more relevant in high-risk patients (ASA III-IV), even if the majority of them were operated by open approach (67.1%).

CONCLUSIONS

In a real-life setting, laparoscopy decreases wound infection rate, post-operative complications, and length of stay, especially in ASA III-IV patients.

Robotic Surgery for Rectal Cancer: An Update in 2015

During the last decade, robotic surgery for rectal cancer has rapidly gained acceptance among colorectal surgeons worldwide, with well-established safety and feasibility. The lower conversion rate and better surgical specimen quality of robotic compared with laparoscopic surgery potentially improves survival. Earlier recovery of voiding and sexual function after robotic total mesorectal excision is another favorable outcome. Long-term survival data are sparse with no evidence that robotic surgery offers major benefits in oncological outcomes. Although initial reports are promising, more rigorous scientific evaluation in multicenter, randomized clinical trials should be performed to definitely determine the advantages of robotic rectal cancer surgery.