Association of laparoscopic colectomy versus open colectomy on the long-term health-related quality of life of colon cancer survivors

Abstract

Background: Laparoscopic colectomy (LC) is a less invasive alternative to open colectomy (OC) in the treatment of stage I-III colon cancer. Research on the long-term (5-year post-diagnosis) health-related quality of life (HRQOL) of LC patients is scarce. Our study aimed to compare the long-term HRQOL and psychological well-being of stage I-III colon cancer survivors treated either with LC or OC.

Methods: This study used a German population-based cohort of patients treated with either LC (n = 86) or OC (n = 980). LC patients were matched to OC patients using a propensity score. At 5-year follow-up, patients completed assessments on HRQOL (EORTC QLQ-C30 and EORTC QLQ-CR29) and psychological well-being (distress and disease/treatment burden). Least square mean scores of HRQOL were derived using linear regression. Proportions of patients with moderate/high distress and disease/treatment burden were compared with Chi-square tests.

Results: In total, 81 LC patients were matched to 156 OC patients. Generally, LC patients had HRQOL comparable to OC patients, albeit LC patients reported significantly better body image (87.1 versus 81.0, p = 0.03). Distress levels were generally low and comparable between the two groups, even though LC patients were more likely to experience disease recurrence (16% versus 7%, p = 0.02) than OC patients. OC patients were more likely to feel moderate/high levels of burden associated with the treatment (72% versus 56%, p = 0.01) and the time after treatment completion (43% versus 28%, p = 0.02).

Conclusion: LC patients reported comparable long-term HRQOL outcomes but higher levels of psychological well-being than OC patients 5 years after diagnosis, even though LC was associated with higher risk of disease recurrence.

Keywords: Colon cancer; Health-related quality of life; Laparoscopy; Long-term survivor; Population based; Propensity score.

Fig. 1

Mean EORTC QLQ-C30 scores of stage I–III colon cancer patients, stratified by treatment and matched by propensity score (LC: n = 81, OC: n = 156). For functioning subscales, higher scores indicate better functioning; for symptom subscales, higher scores indicate higher symptom burden. Propensity score derived from baseline covariates including age at diagnosis, gender, tumor stage, tumor location, hospital volume, education, comorbidity, employment status, place of residence, BMI, smoking status, alcohol use

Fig. 2

Mean EORTC QLQ-CR29 scores of stage I–III colon cancer patients, stratified by treatment and matched by propensity score (LC: n = 81, OC: n = 156). For functioning subscales, higher scores indicate better functioning; for symptom subscales, higher scores indicate higher symptom burden. Propensity score derived from baseline covariates including age at diagnosis, gender, tumor stage, tumor location, hospital volume, education, comorbidity, employment status, place of residence, BMI, smoking status, alcohol use

Fig. 3

Percentage of patients who scored ≥ 4 on relevant single items of the Questionnaire on Distress in Cancer Survivors (QSC-R10) [28], using propensity score matched sample (LC: n = 81, OC: n = 156)

Fig. 4

Percentage of patients who scored ≥ 3 on aspects of burden of cancer and its treatment, using propensity score matched sample (LC: n = 81, OC: n = 156)