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Evolution of Short-Term Outcomes of Laparoscopic Surgery for Colon Cancer
Ramzi Amri1,2, Anne M. Dinaux*1,2, Liliana G. Bordeianou1,2, David L. Berger1,2
1Surgery, Harvard Medical School, Boston, MA; 2General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA
Background
Minimally invasive techniques to perform elective colectomy for colon cancer are becoming a more frequently chosen approach. General assumptions are that a laparoscopic procedure takes longer, but improves recovery and time to discharge. This study compares differences in operation duration and in-hospital admission duration between open and laparoscopic resections and their evolution over time.
Methods
All elective colon cancer cases with primary anastomosis and curative intent operated on at our center (2004-2011), using either an open or purely laparoscopic approach were included (n=785). Median admission and operation durations were compared between open (n=603) and laparoscopic resections (n=182), also comparing the 2004-2007 interval with 2008-2011. Multivariable regression assessed these relationships while controlling for the age, ASA-score, BMI, adhesions, operative complications, additional procedures, gender, multivisceral resection, procedure anatomical region, stapled anastomosis, and operating surgeon, where relevant.
Results
Patients with a laparoscopic approach initially underwent significantly longer operations (median: 147 vs. 111 minutes; P<0.001) but had shorter operation times in the second half (105 vs. 118; P<0.001). Admissions were a median of 5 days in open colectomies, while being shorter and decreasing in laparoscopic admissions (2004-2007:4 days; P=0.007; 2007-2011:3 days; P<0.001). Multivariable models confirm the odds of having an admission of 4 days or less became increasingly more likely in laparoscopic procedures (2004-2007:OR=1.54;P=0.20; 2007-2011:OR=2.95;P<0.001). Conversely, the advantage of surgery duration in open procedures decreased and was no longer significant (2004-2007:OR=0.47;P=0.045; 2008-2011:OR=0.63;P=0.09)
Conclusion
Minimally invasive approaches for colon cancer resections initially increase operation duration, but also decrease admission duration compared to an open approach. Over time and with adequate selection, laparoscopic surgery does not take any longer than open procedures and can even become shorter on average, while the beneficial effect on admission duration improves further with time.
| | All patients
(n=785) | 2004-2007
(n=421) | 2008-2011
(n=364) | | | Open
(n=603) | Laparoscopic
(n=182) | P-value | Open
(n=370) | Laparoscopic
(n=51) | P-value | Open
(n=233) | Laparoscopic
(n=131) | P-value | Duration of surgery
minutes (median, IQR) | 114 (101) | 117 (94) | 0.23 | 111 (101) | 147 (84) | <0.001 | 118 (97) | 105 (99) | 0.52 | Admission duration
days (median, IQR) | 5 (2) | 3 (2) | <0.001 | 5 (2) | 4 (2) | 0.007 | 5 (4) | 3 (2) | <0.001 | Binary logistic regression:
Laparoscopic vs. open | OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value | Surgery
<2 hours | univariate | 0.93 (0.67-1.31) | 0.70 | 0.46 (0.25-0.84) | 0.012 | 1.33 (0.86-2.04) | 0.20 | | multivariable | 0.59 (0.38-0.92) | 0.019 | 0.47 (0.22-0.98) | 0.045 | 0.63 (0.37-1.08) | 0.090 | Admission
<4 days | univariate | 2.80 (1.97-3.98) | <0.001 | 1.62 (0.89-2.94) | 0.11 | 4.68 (2.94-7.44) | <0.001 | | multivariable | 2.06 (1.41-3.02) | <0.001 | 1.54 (0.80-2.99) | 0.20 | 2.95 (1.77-4.90) | <0.001 |
Binary logistic regression. Covariables modeled (selected trough backward elimination): Age, ASA, BMI, Adhesions, Complicated procedure, Extra/combined procedures, Gender, Multivisceral resection, Procedure region, Stapled anastomosis, Surgeon.
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