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Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP

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Abstract

Purpose

The safety and feasibility of minimally invasive surgery (MIS) in the setting of colorectal cancer emergencies have been debated. We sought to compare postoperative outcomes of MIS with open techniques in the setting of colorectal cancer emergencies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

Methods

We included patients undergoing colectomy for colorectal cancer emergency between 2012 and 2019 "2012-2019" from the ACS-NSQIP dataset. We compared short-term morbidity, mortality, short-term oncological outcomes, and secondary outcomes for MIS vs open colectomies using propensity score matching. We then evaluated the trends of MIS versus open colectomies using linear regression analysis.

Results

We examined a total of 5544 patients (open n = 4070; MIS n = 1474) and included 1352 patients for our postoperative outcome analyses after propensity score matching 1:1 (open n = 676; MIS n = 676). Within the matched cohort, mortality was significantly higher in the open group (open 6.95% vs MIS 3.99%, OR 1.8, p = 0.023). Anastomotic leak rates were comparable between the  two groups (open 4.46% vs MIS 4.02%, OR 1.12, p = 0.787). Pulmonary complications were significantly higher after open surgery (open 10.06% vs MIS 4.73%, OR 2.25, p < 0.001). Rates of ileus were significantly higher amongst open patients (open 29.08% vs MIS 19.94%, p < 0.001). Patients stayed on average 1 day longer in the hospital after open surgery (p < 0.001). Rates of MIS for early tumors (N0 and T1/T2, n = 289) did not significantly change over 7 years (p = 0.597, rate = − 0.065%/year); however, utilization of MIS for late tumors (N1 or T3/T4, n = 4359) increased by 2.06% per year (p < 0.001).

Conclusions

This study demonstrates that MIS was associated with superior postoperative outcomes compared to open surgery without compromising oncological outcomes in patients undergoing emergency colectomy for colon cancer. Within the matched cohort, MIS was associated with lower rates of mortality, pulmonary complications, ileus, and shorter postoperative length of stay.

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Data availability

The data that were used are housed with the American College of Surgeons and are available in de-identified fashion to participants of the NSQIP program.

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Funding

This study received no funding.

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Authors and Affiliations

  1. Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, 10016, USA

    J. Chang, E. Assouline, K. Calugaru & Z. Z. Gajic

  2. NYU Grossman School of Medicine, NYU Langone Health, 305 East 33rd Street, New York, NY, 10016, USA

    V. Doğru, J. J. Ray, A. Erkan, E. Esen, M. Grieco & F. Remzi

Authors
  1. J. Chang
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  2. E. Assouline
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  3. K. Calugaru
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  4. Z. Z. Gajic
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  5. V. Doğru
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  6. J. J. Ray
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  7. A. Erkan
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  8. E. Esen
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  9. M. Grieco
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  10. F. Remzi
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Corresponding author

Correspondence to F. Remzi.

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Conflict of interest

Jinhee Chang, Ethan Assouline, Kimberly Calugaru, Zoran Z. Gajic, Volkan Doğru, Juliet J. Ray, Arman Erkan, Eren Esen, Michael Grieco and Feza Remzi have no conflicts of interest or financial ties to disclose.

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This study is exempt from ethical approval nor requires informed consent since it utilized deidentified patient data.

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Chang, J., Assouline, E., Calugaru, K. et al. Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP. Tech Coloproctol 27, 1065–1071 (2023). https://doi.org/10.1007/s10151-023-02852-9

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  • DOI: https://doi.org/10.1007/s10151-023-02852-9

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