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Short-Term Outcomes After Laparoscopic-Assisted Compared to Open Colectomy for Cancer
Karl Y. Bilimoria*1, David J. Bentrem1, Heidi Nelson2, Steven J. Stryker1, Clifford Y. Ko3, Nathaniel J. Soper1
1Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; 2Department of Surgery, Mayo Clinic, Rochester, MN; 3Department of Surgery, UCLA and Greater Los Angeles VA, Los Angeles, CA
Background: Randomized clinical trials have demonstrated that laparoscopic-assisted colectomy (LAC) outcomes are comparable to open colectomy (OC) when performed by experts; however, LAC has not been examined in a multi-institutional setting outside of trials. The objectives of this study were to assess differences in perioperative outcomes for LAC compared to OC.
Methods: Using the American College of Surgeons-National Surgical Quality Improvement Project’s (NSQIP) participant-use dataset, patients were identified who underwent colectomy for cancer at 120 participating hospitals in 2005-2006. Multiple logistic regression was used to assess the risk-adjusted association between surgical approach (LAC vs. OC) and 30-day outcomes. Propensity scores were used to adjust for group differences. Patients were excluded if they underwent emergent procedures, were ASA class 5, or had metastatic disease.
Results: Of the 3,059 patients who underwent colectomy for cancer, 837 (27.4%) underwent LAC and 2,222 (72.6%) underwent OC. There were no significant differences in age, comorbidities, ASA class, or BMI between patients undergoing LAC vs. OC. Patients undergoing LAC had a lower likelihood of developing any adverse event (includes wound, cardiac, pulmonary, renal, neurologic, or hematologic complications) compared to OC (14.6% vs. 21.7%; OR 0.64, 95% CI 0.51-0.81, P<0.0001) (Table). Mean length of stay was significantly shorter after LAC vs. OC (6.2 vs. 8.7 days, P<0.0001). There was no difference between LAC and OC in the rate of returns to the operating room (5.5% vs. 5.8%, P=0.79) or 30-day mortality (1.4% vs. 1.8%, P=0.53).
Conclusions: LAC was utilized in one-quarter of patients with colon cancer. LAC was associated with lower morbidity and length of stay in select patients.
