Short-term outcomes of minimally invasive versus open colectomy for colon cancer

Abstract

Background: Laparoscopic and open approaches to colon resection have equivalent long-term outcomes and oncologic integrity for the treatment of colon cancer. Differences in short-term outcomes should therefore help to guide surgeons in their choice of operation. We hypothesized that minimally invasive colectomy is associated with superior short-term outcomes compared to traditional open colectomy in the setting of colon cancer.

Materials and methods: Patients undergoing nonemergent colectomy for colon cancer in 2012 and 2013 were selected from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted colectomy participant use file. Patients were divided into two cohorts based on operative approach-open versus minimally invasive surgery (MIS). Univariate, multivariate, and propensity-adjusted multivariate analyses were performed to compare postoperative outcomes between the two groups.

Results: A total of 11,031 patients were identified for inclusion in the study, with an overall MIS rate of 65.3% (n = 7200). On both univariate and multivariate analysis, MIS approach was associated with fewer postoperative complications and lower mortality. In the risk-adjusted multivariate analysis, MIS approach was associated with an odds ratio of 0.598 for any postoperative morbidity compared to open (P < 0.001).

Conclusions: This retrospective study of patients undergoing colectomy for colon cancer demonstrates significantly improved outcomes associated with a MIS approach, even when controlling for baseline differences in illness severity. When feasible, minimally invasive colectomy should be considered gold standard for the surgical treatment of colon cancer.

Keywords: Colectomy; Colonic neoplasms; Laparoscopy; Minimally invasive surgical procedures.

Fig. 1 –

Flow diagram showing selection of analytic cohort for the study.

Fig. 2 –

Percentage of each propensity score quintile group with (A) any 30-d postoperative complication, (B) infectious complications, (C) noninfectious complications, and (D) 30-d mortality.

Fig. 3 –

Average operative time within each propensity score quintile based on operative approach.

Fig. 4 –

Mean total hospital length of stay (LOS) by propensity score quintile based on operative approach. All LOS recorded >30 were treated as 30 d. Those cases with missing LOS data were excluded.