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A Comparison of Lymph Node Harvest Following Emergent Laparoscopic Versus Open Colectomy for Colon Cancer: Results From the ACS-NSQIP Database
Jad Abou Khalil^*1, Ebram Salama ², Philip Gordon³, Carol-Ann Vasilevsky³, Gabriella Ghitulescu³, Nancy Morin³, Julio Faria³, Marie Demian³, Marylise Boutros^3
1General Surgery, McGill University, Montreal, QC, Canada; ²McGill University, Montreal, QC, Canada; ³Jewish General Hospital, Montreal, QC, Canada

Background:The outcomes of laparoscopy for colon cancer in the elective setting are widely reported, however its use in the emergency setting is not well studied. The objective of this study was to compare adequacy of lymph node harvest for emergency laparoscopic vs. open colon cancer resections.Methods:Following institutional review board approval, the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) colectomy-specific database for 2011-2014 was reviewed. Patients with a diagnosis of colon cancer who underwent emergent resections were selected. Patients who underwent a laparoscopic-converted resection were included in the open group. The primary outcome was 12 or more lymph nodes (LN) harvested (adequate LN harvest), and the secondary outcomes were surgical site infections and major morbidity. In order to adjust for differences in patient characteristics, 1-to-1 coarsened-exact matching (CEM) on age, gender, race, body mass index, American Society of Anesthesiologists classification, preoperative intubation, sepsis, preoperative chemotherapy, T-stage and M-stage was performed. Patients were grouped according to the type of resection (ileocolic, segmental colon, and left-sided colon including upper rectal resections) and after matching, each group was analyzed separately using multivariate logistic regression.
Results:Of 5114 patients who met the inclusion criteria, 3282 and 1832 underwent open and laparoscopic resections, respectively. Patients with open resections group had more preoperative comorbidities than patients with laparoscopic resections. Adequate lymph node harvests were attained in 92.3% and 93.6% of open and laparoscopic resections respectively (p=0.10) and were similar in the ileocolic (93.2% vs. 95.5%, p=0.55), segmental colon (93.8% vs. 93.7%, p=0.83), and left-sided colon including rectal (89.1% vs. 90.3%, p=0.81) resections, respectively. Mean harvested nodes did not differ between colectomy groups. CEM resulted in 456, 694, and 272 matches in the ileocolic, segmental colon, and left-sided colon including rectal resections, respectively. On multivariate regression, the odds of adequate LN harvests were similar in open vs. laparoscopic groups for patients with ileocolic (OR 1.64, 95%CI 0.73-3.71), segmental colon (OR 1.00, 95%CI 0.52-1.92), and left-sided colon including rectal (OR 0.79, 95%CI 0.37-1.72) resections, respectively. On multivariate regression, laparoscopy was associated with significantly lower odds of surgical site infections (OR=0.55,95% CI 0.46-0.61) and major morbidity (OR=0.58, 95% CI 0.48-0.68).Conclusion :
In this large cohort, the use of laparoscopy did not compromise adequate LN harvests in patients who underwent emergent colon cancer resections.

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