SSAT - OUTCOMES OF SYNCHRONOUS SEGMENTAL VERSUS TOTAL COLECTOMIES FOR COLON CANCER: AN AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM ANALYSIS

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OUTCOMES OF SYNCHRONOUS SEGMENTAL VERSUS TOTAL COLECTOMIES FOR COLON CANCER: AN AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM ANALYSIS
Sebastien Lachance^*, Nancy Morin, Carol-Ann Vasilevsky, Gabriela Ghitulescu, Julio Faria, Philip H. Gordon, Marylise Boutros
Division of Colorectal Surgery, , Jewish General Hospital, McGill University, Montreal, QC, Canada

Background: Total and synchronous segmental colectomies are acceptable options for synchronous colon cancers, despite scarce data on postoperative outcomes. This study aimed to assess 30-day major morbidity and mortality of patients with colon cancer who underwent total or synchronous segmental colectomies.
Methods: After institutional review board approval, a retrospective analysis of data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was conducted. Adult patients with colon cancer who underwent elective total or synchronous segmental colectomies between 2005-2015 were identified using the International Classification of Diseases 9 and Current Procedural Terminology codes. The primary outcomes were 30-day major morbidity and mortality. Secondary outcomes were hospital length of stay and readmission rates. Multivariate logistic and binomial regressions were used as appropriate.
Results: In the ACS-NSQIP database, 668 and 2467 patients with colon cancer underwent synchronous segmental and total colectomies, respectively. Patients with synchronous segmental colectomies were older (68 vs. 58 years, p<0.0001), had more ASA scores of 3 (57.2% vs. 47.4%, p<0.0001), decreased rates of smoking (16.3% vs. 23.3%, p=0.0001), and had increased rates of diabetes (23.4% vs. 15.5%, p<0.0001), pre-operative weight loss (7.8% vs. 5.3%, p=0137) and hypertension (62.9% vs. 44.5%, p<0.0001). Patients with synchronous segmental resections had a decreased unadjusted rate of 30-day major morbidity (17.2% vs. 20.7%; p=0.0448), hospital length of stay (7.80 vs. 9.0 days; p=0.0001), readmission rates (1.2% vs. 2.5%; p=0.0181), and operative time (184 vs. 233 min, p<0.0001). No statistically significant differences were found between groups for unadjusted rates of superficial (6.0% vs. 6.6%) and organ space (4.9% vs. 5.6%) surgical site infections, and 30-day mortality (2.2% vs. 1.6%). On multivariate logistic regression, synchronous segmental colectomies did not differ significantly compared to total colectomy for readmission rates [OR = 0.737 (95% CI, 0.203-2.672)], 30-day major morbidity [OR = 0.792 (95% CI, 0.615-1.021)], and 30-day mortality [OR = 1.055 (95% CI, [0.536, 2.074). However, difference in hospital length of stay remained statistically different when adjusted for confounders [OR = -0.18 (95% CI, -0.23, -0.12)].
Conclusion: To our knowledge, this is the largest study to compare outcomes following synchronous segmental or total colectomies for colon cancer. These two procedures were equally safe when compared on the basis of 30-day major morbidity, mortality, and readmission. For older patients, in whom colon preservation may be important for function, two anastomoses may be performed without any increased risk. These findings should be taken into account in operative planning for synchronous colon cancers.

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