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Laparoscopic surgery reduced frequency of postoperative small bowel obstruction, and hospital stay compared with open surgery in a cohort of patients with colorectal cancer: a propensity score matching analysis

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A Correction to this article was published on 20 December 2023

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Abstract

Background

Laparoscopic surgery (LS) is reported to reduce postoperative complications and hospital stay compared with open surgery (OP). Because patient selection may have been biased in previous studies, propensity score matching (PSM) analysis was used in this study to test the benefits of LS compared with OP.

Methods

A total of 759 patients with stage I–III colorectal cancer undergoing curative surgery were retrospectively reviewed. To minimize confounding bias between LS and OP groups, a 1:1 PSM analysis was performed based on adjuvant chemotherapy, age, albumin, body mass index, American Society of Anesthesiologists physical status depth of tumor, gender, lymph node dissection, maximum tumor size, obstructive tumor, previous abdominal surgery, pathological stage, tumor differentiation, and tumor location. Statistical analyses including chi-square test, Mann–Whitney U test, univariate analyses and Kaplan–Meier method and log-rank test were performed using the data after PSM to investigate the benefits of LS compared with OP.

Results

After PSM analysis, 460 patients remained in the study. The LS group had lower intraoperative blood loss (34 ± 70 vs 237 ± 391, mL; P < 0.001), lower frequency of postoperative small bowel obstruction (SBO) (17/213 vs 30/230; P = 0.045), lower rate of nasogastric tube insertion (7/223 vs 17/213; P = 0.036), and shorter postoperative hospital stay (13 ± 10 vs 25 ± 47, day; P < 0.001) than the OP group. Univariate analyses showed that LS significantly reduced the risk of postoperative SBO (odds ratio [OR] 0.532; 95% confidence interval [CI] 0.285–0.995; P = 0.048) and nasogastric tube insertion (OR 0.393; 95% CI 0.160–0.967; P = 0.042) compared with OP. There were no significant differences in OS and RFS between the groups.

Conclusions

LS reduced intraoperative blood loss, frequency of postoperative SBO, rate of nasogastric tube insertion, and postoperative hospital stay compared with OP.

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Abbreviations

ASA-PS:

American Society of Anesthesiologists physical status

BMI:

Body mass index

CRC:

Colorectal cancer

LS:

Laparoscopic surgery

OP:

Open surgery

OS:

Overall survival

PSM:

Propensity score matching

SBO:

Small bowel obstruction

RFS:

Recurrence-free survival

ROC:

Receiver operating characteristic

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.

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Authors and Affiliations

  1. Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan

    Kotaro Suda, Takayuki Shimizu, Mitsuru Ishizuka, Shotaro Miyashita, Maiko Niki, Norisuke Shibuya, Hiroyuki Hachiya, Takatsugu Matsumoto, Takayuki Shiraki, Yuhki Sakuraoka, Shozo Mori, Yukihiro Iso, Kazutoshi Takagi, Taku Aoki & Keiichi Kubota

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  1. Kotaro Suda
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  2. Takayuki Shimizu
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  3. Mitsuru Ishizuka
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  4. Shotaro Miyashita
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Contributions

KS wrote the manuscript. TS was corresponding author, revised the manuscript, performed statistical analyses and planed the study design. The authors wish to thank MI, TA and KK for their advice on the study design. In addition, the authors would like to thank the timely help given by SM, MN, NS, HH, TM, TS, YS, SM, YI and KT in collecting the large amount of patients’ data.

Corresponding author

Correspondence to Takayuki Shimizu.

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Disclosures

Kotaro Suda, Takayuki Shimizu, Mitsuru Ishizuka, Shotaro Miyashita, Maiko Niki, Norisuke Shibuya, Hiroyuki Hachiya, Takatsugu Matsumoto, Takayuki Shiraki, Yuhki Sakuraoka, Shozo Mori, Yukihiro Iso, Kazutoshi Takagi, Taku Aoki, Keiichi Kubota have no conflicts of interest or financial ties to disclose.

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Suda, K., Shimizu, T., Ishizuka, M. et al. Laparoscopic surgery reduced frequency of postoperative small bowel obstruction, and hospital stay compared with open surgery in a cohort of patients with colorectal cancer: a propensity score matching analysis. Surg Endosc 36, 8790–8796 (2022). https://doi.org/10.1007/s00464-022-09302-x

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