ArticleClinical epidemiology2026
Comparative Effectiveness of Laparoscopic versus Open Colectomy on 5-Year Overall Survival in Non-Metastatic Colon Cancer: A Target Trial Emulation Study Using Retrospective Cohort Data from a Cancer Registry.
Article in Clinical epidemiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
Background: The clinical acceptance of laparoscopic colectomy (LC) as a standard alternative treatment for colon cancer hinges primarily on evidence of favorable long-term oncological outcome. The aim of this study was to compare the 5-year overall survival (OS) between stage I-III colon cancer patients who underwent either LC or open colectomy (OC). Materials and Methods: A target trial emulation (TTE) design was implemented using statewide retrospective cohort data from the Mecklenburg-Western Pomerania Cancer Registry spanning 2008 to 2018. The causal interpretation of TTE relied on the assumptions of consistency, conditional exchangeability, and positivity. The Royston-Parmar parametric survival model was applied to estimate the hazard ratio with bootstrapped 95% confidence interval (95% CI). This was complemented by differences in estimates of restricted mean survival time (RMST). Sensitivity analyses, including the E-value method, were conducted to assess the robustness of the estimated treatment effect. Three traditional (fully adjusted, change-in-estimate, and Directed Acyclic Graph-guided) Cox models were performed for comparison purposes. Results: We included 1265 patients, of whom 30% (n= 380) received LC. The estimated HR for 5-year OS comparing LC with OC was 0.81 (95% CI: 0.60, 1.08). RMST differences for OS favored LC, but the effects were small: 0.12 months (95% CI: -0.10, 0.34), 0.36 months (95% CI: -0.15, 0.87), and 1.20 months (95% CI: -0.20, 2.60) up to 1-, 3-, and 5-years, respectively. Sensitivity analyses generally confirmed the robustness of the results. Traditional Cox models showed a survival advantage for LC, but all were affected by bias. Conclusion: This study found comparable 5-year OS between LC and OC. The traditional Cox models spuriously overestimated the survival advantage of LC. TTE can provide useful real-world evidence for comparative effectiveness in surgical oncology, particularly when randomized evidence is limited, but it cannot replace well-conducted RCTs.
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