Laparoscopic-assisted vs. Open Colectomy for Cancer: Comparison of Short-term Outcomes from 121 Hospitals

  • Karl Y. Bilimoria
  • David J. Bentrem
  • Ryan P. Merkow
  • Heidi Nelson
  • Edward Wang
  • Clifford Y. Ko
  • Nathaniel J. Soper
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DOI: 10.1007/s11605-008-0568-x

Cite this article as:
Bilimoria, K.Y., Bentrem, D.J., Merkow, R.P. et al. J Gastrointest Surg (2008) 12: 2001. doi:10.1007/s11605-008-0568-x

Abstract

Background

Overall postoperative morbidity and mortality after laparoscopic-assisted colectomy (LAC) and open colectomy (OC) have been shown to be generally comparable; however, differences in the occurrence of specific complications are unknown. The objective of this study was to determine whether certain complications occurred more frequently after LAC vs. OC for colon cancer.

Methods

Using the American College of Surgeons-National Surgical Quality Improvement Project’s (ACS-NSQIP) participant-use file, patients were identified who underwent colectomy for cancer at 121 participating hospitals in 2005–2006. Multiple logistic regression models including propensity scores were developed to assess the risk-adjusted association between surgical approach (LAC vs. OC) and 30-day outcomes. Patients were excluded if they underwent emergent procedures, were ASA class 5, or had metastatic disease.

Results

Of the 3,059 patients who underwent elective 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 body mass index (BMI) between patients undergoing LAC vs. OC. Patients undergoing LAC had a lower likelihood of developing any adverse event compared to OC (14.6% vs. 21.7%; OR 0.64, 95% CI 0.51–0.81, P < 0.0001), specifically surgical site infections, urinary tract infections, and pneumonias. Mean length of stay was significantly shorter after LAC vs. OC (6.2 vs. 8.7 days, P < 0.0001). There were no differences between LAC and OC in the reoperation rate (5.5% vs. 5.8%, P = 0.79) or 30-day mortality (1.4% vs. 1.8%, P = 0.53).

Conclusions

Laparoscopic-assisted colectomy was associated with lower morbidity compared to OC in select patients, specifically for infectious complications.

Keywords

Colon cancer Colectomy Laparoscopy Cancer Surgery National Surgical Quality Improvement Program 

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Karl Y. Bilimoria
    • 1
  • David J. Bentrem
    • 1
  • Ryan P. Merkow
    • 2
  • Heidi Nelson
    • 3
  • Edward Wang
    • 1
  • Clifford Y. Ko
    • 4
  • Nathaniel J. Soper
    • 1
  1. 1.Department of Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Department of SurgeryUniversity of Colorado School of MedicineDenverUSA
  3. 3.Department of SurgeryMayo ClinicRochesterUSA
  4. 4.Department of SurgeryUniversity of California, Los Angeles (UCLA) and VA Greater Los Angeles Healthcare SystemLos AngelesUSA