World Journal of Surgery

, Volume 37, Issue 10, pp 2458–2467 | Cite as

Short- and Long-term Outcomes After Laparoscopic Versus Open Emergency Resection for Colon Cancer: An Observational Propensity Score-matched Study

  • Manfred Odermatt
  • Danilo Miskovic
  • Najaf Siddiqi
  • Jim Khan
  • Amjad Parvaiz
Article

Abstract

Background

Case series suggest the feasibility and safety of emergency resection of colon cancer by laparoscopy. The present study compares short- and long-term outcomes of laparoscopic and open resection for colon cancers treated as emergencies.

Methods

The study was a propensity score-matched design based on a prospective database. From October 2006 to December 2011, emergency laparoscopic colon cancer resections were 1:2 propensity score-matched to open cases. Covariates for match-estimation were age, gender, American Society of Anesthesiologists grade, procedure type, tumor site, and reason for emergency surgery. Short-term outcomes included oncological quality surrogates (lymph node harvest and R stage), need for a stoma, length of hospital stay, and postoperative complications. For long-term outcomes, overall and recurrence-free survival rates were analyzed with Kaplan–Meier curves.

Results

During the study period, a total of 217 colon cancers were resected (181 open and 36 laparoscopic) as emergencies. The laparoscopic cases were matched to 72 open cases. Median follow-up was 3.6 [95 % confidence interval (CI) 2.3–4.3] years. The overall 3-year survival rate was 51 % (95 % CI 35–76) in the laparoscopic group versus 43 % (95 % CI 32–58) in the open group (p = 0.24). The 3-year recurrence-free survival rate in the laparoscopic group was 35 % (95 % CI 20–60) versus 37 % (95 % CI 27–50) in the open group (p = 0.53). Median lymph node harvest (17 vs. 13 nodes; p = 0.041) and median length of hospital stay (7.5 vs. 11.0 days; p = 0.019) favored laparoscopy.

Conclusions

Our data suggest that selective emergency laparoscopy for colon cancer is not inferior to open surgery with regard to short- and long-term outcomes. Laparoscopy resulted in a shorter length of hospital stay.

Notes

Acknowledgments

The authors thank Felix Thoemmes, Cornell University, New York, for statistical advice and Karen Flashman, Queen Alexandra Hospital, Portsmouth, UK, for data collection.

Conflict of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388PubMedCrossRefGoogle Scholar
  2. 2.
    Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRefGoogle Scholar
  3. 3.
    Group COoSTS (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRefGoogle Scholar
  4. 4.
    Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar
  5. 5.
    Newman CM, Arnold SJ, Coull DB (2012) The majority of colorectal resections require an open approach, even in units with a special interest in laparoscopic surgery. Colorectal Dis 14:29–34 (discussion 42–23)PubMedCrossRefGoogle Scholar
  6. 6.
    Wise J (2011) Mortality from emergency bowel cancer surgery remains high. BMJ 343:d7742PubMedCrossRefGoogle Scholar
  7. 7.
    Marcello PW, Milsom JW, Wong SK et al (2001) Laparoscopic total colectomy for acute colitis: a case-control study. Dis Colon Rectum 44:1441–1445PubMedCrossRefGoogle Scholar
  8. 8.
    Ng SS, Lee JF, Yiu RY et al (2008) Emergency laparoscopic-assisted versus open right hemicolectomy for obstructing right-sided colonic carcinoma: a comparative study of short-term clinical outcomes. World J Surg 32:454–458. doi: 10.1007/s00268-007-9400-0 PubMedCrossRefGoogle Scholar
  9. 9.
    Morino M, Bertello A, Garbarini A et al (2002) Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections. Surg Endosc 16:1483–1487PubMedCrossRefGoogle Scholar
  10. 10.
    Stipa F, Pigazzi A, Bascone B et al (2008) Management of obstructive colorectal cancer with endoscopic stenting followed by single-stage surgery: open or laparoscopic resection? Surg Endosc 22:1477–1481PubMedCrossRefGoogle Scholar
  11. 11.
    Iversen LH, Kratmann M, Boje M et al (2011) Self-expanding metallic stents as bridge to surgery in obstructing colorectal cancer. Br J Surg 98:275–281PubMedCrossRefGoogle Scholar
  12. 12.
    Champagne B, Stulberg JJ, Fan Z et al (2009) The feasibility of laparoscopic colectomy in urgent and emergent settings. Surg Endosc 23:1791–1796PubMedCrossRefGoogle Scholar
  13. 13.
    Ng SS, Yiu RY, Li JC et al (2006) Emergency laparoscopically assisted right hemicolectomy for obstructing right-sided colon carcinoma. J Laparoendosc Adv Surg Tech A 16:350354Google Scholar
  14. 14.
    Fowkes L, Krishna K, Menon A et al (2008) Laparoscopic emergency and elective surgery for ulcerative colitis. Colorectal Dis 10:373–378PubMedCrossRefGoogle Scholar
  15. 15.
    Ballian N, Weisensel N, Rajamanickam V et al (2012) Comparable postoperative morbidity and mortality after laparoscopic and open emergent restorative colectomy: outcomes from the ACS NSQIP. World J Surg 36:2486–2496. doi: 10.1007/s00268-012-1694-x CrossRefGoogle Scholar
  16. 16.
    National Training Programme for Laparoscopic Colorectal Surgery. http://www.lapco.nhs.uk. Accessed 19 June 2013
  17. 17.
    Coleman MG, Hanna GB, Kennedy R (2011) The National Training Programme for Laparoscopic Colorectal Surgery in England: a new training paradigm. Colorectal Dis 13:614–616PubMedCrossRefGoogle Scholar
  18. 18.
    Shawki S, Bashankaev B, Denoya P et al (2009) What is the definition of “conversion” in laparoscopic colorectal surgery? Surg Endosc 23:2321–2326PubMedCrossRefGoogle Scholar
  19. 19.
    Iacus SM, King G, Porro G (2011) Multivariate matching methods that are monotonic imbalance bounding. J Am Stat Assoc 106:345–361CrossRefGoogle Scholar
  20. 20.
    Campbell MJ, Julious SA, Altman DG (1995) Estimating sample sizes for binary, ordered categorical, and continuous outcomes in two group comparisons. BMJ 311:1145–1148PubMedCrossRefGoogle Scholar
  21. 21.
    R Core Team (2012) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org/
  22. 22.
    Therneau T (2012) A package for survival analysis in S. R package version 2.36-14Google Scholar
  23. 23.
    Thoemmes F (2011) An SPSS R menu for propensity score matching. http://arxiv.org/abs/1201.6385
  24. 24.
    Ho D, Imai K, King G et al (2011) MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw 42:1–28Google Scholar
  25. 25.
    Ho D, Imai K, King G et al (2007) Matching as nonparametric preprocessing for reducing model dependence in parametric causal inference. Political Analysis 15:199–236CrossRefGoogle Scholar
  26. 26.
    Bowers J, Fredrickson M, Hansen B (2010) RItools: randomization inference tools. R package version 0.1–11Google Scholar
  27. 27.
    Hansen B, Bowers J (2008) Covariate balance in simple, stratified and clustered comparative studies. Stat Sci 23:219–236CrossRefGoogle Scholar
  28. 28.
    Iacus S, King G, Porro G (2009) CEM: software for coarsened exact matchingGoogle Scholar
  29. 29.
    Gooiker GA, Dekker JW, Bastiaannet E et al (2012) Risk factors for excess mortality in the first year after curative surgery for colorectal cancer. Ann Surg Oncol 19:2428–2434PubMedCrossRefGoogle Scholar
  30. 30.
    Mamidanna R, Eid-Arimoku L, Almoudaris AM et al (2012) Poor 1-year survival in elderly patients undergoing nonelective colorectal resection. Dis Colon Rectum 55:788–796PubMedCrossRefGoogle Scholar
  31. 31.
    Law WL, Choi HK, Lee YM et al (2007) The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol 14:2559–2566PubMedCrossRefGoogle Scholar
  32. 32.
    Thorpe H, Jayne DG, Guillou PJ et al (2008) Patient factors influencing conversion from laparoscopically assisted to open surgery for colorectal cancer. Br J Surg 95:199–205PubMedCrossRefGoogle Scholar
  33. 33.
    Biondo S, Pares D, Frago R et al (2004) Large bowel obstruction: predictive factors for postoperative mortality. Dis Colon Rectum 47:1889–1897PubMedCrossRefGoogle Scholar
  34. 34.
    Chen HS, Sheen-Chen SM (2000) Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery 127:370–376PubMedCrossRefGoogle Scholar
  35. 35.
    Storli KE, Sondenaa K, Bukholm IR et al (2011) Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age. Int J Colorectal Dis 26:1299–1307PubMedCrossRefGoogle Scholar
  36. 36.
    Kuhry E, Schwenk WF, Gaupset R et al. (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev CD003432Google Scholar
  37. 37.
    Stulberg JJ, Champagne BJ, Fan Z et al (2009) Emergency laparoscopic colectomy: does it measure up to open? Am J Surg 197:296–301PubMedCrossRefGoogle Scholar
  38. 38.
    Ohtani H, Tamamori Y, Arimoto Y et al (2012) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer 3:49–57PubMedCrossRefGoogle Scholar
  39. 39.
    National Bowel Cancer Audit Annual Report 2011. The NHS Information Centre. Document reference IC 14110111. www.ic.nhs.uk/bowelreports
  40. 40.
    Ogino S, Nosho K, Irahara N et al (2010) Negative lymph node count is associated with survival of colorectal cancer patients, independent of tumoral molecular alterations and lymphocytic reaction. Am J Gastroenterol 105:420–433PubMedCrossRefGoogle Scholar
  41. 41.
    Wu Z, Zhang S, Aung LH et al (2012) Lymph node harvested in laparoscopic versus open colorectal cancer approaches: a meta-analysis. Surg Laparosc Endosc Percutan Tech 22:5–11PubMedCrossRefGoogle Scholar
  42. 42.
    West NP, Kobayashi H, Takahashi K et al (2012) Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 30:1763–1769PubMedCrossRefGoogle Scholar
  43. 43.
    Bretagnol F, Dedieu A, Zappa M et al (2011) T4 colorectal cancer: is laparoscopic resection contraindicated? Colorectal Dis 13:138–143PubMedCrossRefGoogle Scholar
  44. 44.
    Vlug MS, Wind J, Hollmann MW et al (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875PubMedCrossRefGoogle Scholar
  45. 45.
    Li MZ, Xiao LB, Wu WH et al (2012) Meta-analysis of laparoscopic versus open colorectal surgery within fast-track perioperative care. Dis Colon Rectum 55:821–827PubMedCrossRefGoogle Scholar
  46. 46.
    Lourenco T, Murray A, Grant A et al (2008) Laparoscopic surgery for colorectal cancer: safe and effective?—a systematic review. Surg Endosc 22:1146–1160PubMedCrossRefGoogle Scholar
  47. 47.
    Murray A, Lourenco T, de Verteuil R (2006) Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation. Health Technol Assess 10:1–141 (iii–iv)PubMedGoogle Scholar
  48. 48.
    Vaid S, Tucker J, Bell T et al (2012) Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: results from a large nationwide population database. Am Surg 78:635–641PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Manfred Odermatt
    • 1
  • Danilo Miskovic
    • 1
  • Najaf Siddiqi
    • 1
  • Jim Khan
    • 1
  • Amjad Parvaiz
    • 1
  1. 1.Minimally Invasive Colorectal Unit (MICRU)Queen Alexandra HospitalPortsmouthUK

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