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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Acknowledgments

ACS NSQIP Disclaimer: The ACS NSQIP and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Surgery, Feinberg School of Medicine, Northwestern University, 251 E. Huron Street, Galter 3-150, Chicago, IL, 60611, USA

    Karl Y. Bilimoria, David J. Bentrem, Edward Wang & Nathaniel J. Soper

  2. Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA

    Ryan P. Merkow

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Heidi Nelson

  4. Department of Surgery, University of California, Los Angeles (UCLA) and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Clifford Y. Ko

Authors
  1. Karl Y. Bilimoria
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  2. David J. Bentrem
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  3. Ryan P. Merkow
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  4. Heidi Nelson
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  5. Edward Wang
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  6. Clifford Y. Ko
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  7. Nathaniel J. Soper
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Corresponding author

Correspondence to Karl Y. Bilimoria.

Additional information

This study was presented in part at the 2008 Annual Meeting of the Society for Surgery of the Alimentary Tract in San Diego, CA on May 21, 2008.

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Bilimoria, K.Y., Bentrem, D.J., Merkow, R.P. et al. Laparoscopic-assisted vs. Open Colectomy for Cancer: Comparison of Short-term Outcomes from 121 Hospitals. J Gastrointest Surg 12, 2001–2009 (2008). https://doi.org/10.1007/s11605-008-0568-x

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  • DOI: https://doi.org/10.1007/s11605-008-0568-x

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