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

• DOI: 10.1007/s11605-008-0568-x
• Publication Date: 2008-06-23T15:25:20Z
• Authors: Karl Y. Bilimoria; David J. Bentrem; Ryan P. Merkow; Heidi Nelson; Edward Wang; Clifford Y. Ko; Nathaniel J. Soper
• Keywords: Male; Laparotomy; Colonoscopy; Middle Aged; Risk Assessment; Statistics, Nonparametric; 3. Good health; Cohort Studies; 03 medical and health sciences; Logistic Models; 0302 clinical medicine; ROC Curve; Colonic Neoplasms; Multivariate Analysis; Odds Ratio; Humans; Female; Laparoscopy; Neoplasm Recurrence, Local; Colectomy; Aged; Follow-Up Studies; Retrospective Studies

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