Optimizing Patient Selection for Laparoscopic and Open Colorectal Cancer Resections: A National Surgical Quality Improvement Program–Matched Analysis

Abstract

The aim of this study was to identify patients undergoing colorectal cancer (CRC) resection who might benefit specifically from either an open or laparoscopic approach. From the NSQIP database (2012–2013), patients who underwent laparoscopic colectomy (LC) or open colectomy (OC) for CRC were identified. The two groups were matched and compared in terms of any, medical, and surgical complications. A wide range of patient characteristics were collected and analyzed. Interaction analysis was performed in a multivariable regression model to identify risk factors that may make LC or OC more beneficial in certain subgroups of patients. Overall, OC (n = 6593) was associated with a significantly higher risk of any [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.87–2.20], surgical (OR 1.98, 95% CI 1.82–2.16), and medical (OR 1.71, 95% CI 1.51–1.94) complications than LC (n = 6593). No subgroup of patients benefited from an open approach. Patients with obesity (BMI > 30) (P = 0.03) and older age (>65 years) (P = 0.01) benefited more than average from a laparoscopic approach. For obese patients, LC was associated with less overall complications (OC vs LC: OR 1.92 obese vs 1.21 nonobese patients). For elderly patients, LC was more preferable regarding the risk of medical complications (OC vs LC OR of 1.91 vs 1.34 for younger patients). No subgroup of CRC patients benefited specifically more from an open colorectal resection. This supports that the laparoscopic technique should be performed whenever feasible. For the obese and elderly patients, the benefits of the laparoscopic approach were more pronounced.

Laparoscopic versus open surgery for elderly patients with colorectal cancer: a systematic review and meta‐analysis of matched studies

“…A total of 24 studies were considered for inclusion 31–54 . Table 1 presents the details of the studies included in the review.…”

Safety and feasibility of laparoscopic surgery for elderly rectal cancer patients in Japan: a nationwide study

“…Given that almost half of the 80 years and older patients underwent laparoscopy, this result provides supportive evidence that laparoscopy is more beneficial for elderly patients than younger patients, as reported previously 29 . In some recent studies, aged or frail patients were reported to benefit from laparoscopy more than younger patients 30 , 31 . Although the definitive reason has not been elucidated yet, the present data also showed a similar trend.…”