Short-term outcomes after elective colon cancer surgery: an observational study from the Norwegian registry for gastrointestinal and HPB surgery, NoRGast

Abstract

Background To describe the real burden of major complications after elective surgery for colon cancer in Norway, and to assess which predictors that are significantly associated with the short-term outcome. Methods An observational, multi-centre analysis of prospectively registered colon resections registered into the Norwegian Registry for Gastrointestinal Surgery, NoRGast, between January 2014 and December 2016. A propensity score-adjusted subgroup analysis for surgical access groups was attempted, with laparoscopic resections grouped as intention-to-treat. Results Out of 1812 resections, 14.0% of patients experienced a major complication within 30 days following surgery. The overall reoperation rate was 8.7%, and rate of reoperation for anastomotic leak was 3.8%. Twenty patients (1.1%) died within 30 days after surgery. Higher age was not a significant predictor of major complications, including 30-day mortality. After correction for all co-variables, open access surgery was associated with higher rates of major complications (OR 1.67 (CI 1.22-2.29), p = 0.002), higher 30-day mortality (OR 4.39 (CI 1.19-16.13) p = 0.026) and longer length-of-stay (HR 0.58 (CI 0.52-0.65) p < 0.001). Conclusions Our results indicate a low complication burden and high rate of uneventful patient journeys after elective surgery for colon cancer in Norway. Age was not associated with higher morbidity or mortality rates. Open access surgery was associated with an inferior short-term outcome. Keywords Short-term outcomes • Colon cancer • Elective surgery • Laparoscopy In 2012, Norway reported the world's 6th highest incidence of colorectal cancer [1], and the incidence has for the past decades been steadily increasing [2]. The prognosis following surgical treatment is excellent, with a 5-year relative survival rate of 84% after resection for non-metastatic disease [3]. Even the oldest and most frail patients will often be offered surgery with curative intent. While the potential gain from uneventful surgery is large, the consequences of major complications may be devastating with loss of function and impaired quality of life that are at best temporary.

Lower conversion rate with robotic assisted rectal resections compared with conventional laparoscopy; a national cohort study

“…ASA-scores were grouped into low ASA-scores (scores 1-2) and high ASA-scores (scores 3-4). ECOG-scores were dichotomized into low ECOG-score (0-1) and high ECOG-score (2)(3)(4). Severe pulmonary disease was defined as having FEV1 < 50% or a vital capacity < 60% of predicted values.…”

“…Conversion to open access was followed by higher rates of major complications, reoperations, longer LOS, higher rates of positive CRM, and tumor-near bowel-perforation. Higher rates of complications have been associated with conversion of laparoscopic colon cancer resections in several studies [3][4][5][6][7]. In a study with prospectively collected data of 470 patients who underwent laparoscopic colorectal resections including 192 rectal resections, postoperative complication rates were significantly higher for patients who experienced conversion to open access, with a rate of 56.1% versus 16.8% when resections were completed laparoscopically [37].…”

“…Over the last 10 years, laparoscopic rectal resection has become the preferred approach in many countries [1,2]. While several studies have shown favorable outcomes after laparoscopic surgery for colon cancer [3][4][5][6][7] with reduced rates of postoperative complications, 30-day mortality, and long-term results equal to open access surgery [8][9][10], the results after laparoscopic rectal cancer surgery have not been unambiguously positive. Although studies demonstrate similar short-and long-term results compared to open access surgery [11,12], unfavorable histopathological outcomes with higher rates of positive circumferential resection margins, and lower rates of complete excision of mesorectum after TME have been reported [13,14].…”

“…This might facilitate a more precise dissection with improved specimen quality. In particular, it may also reduce the need for conversion, which is associated with higher complication rates [ 3 , 15 , 20 ]. While several studies have shown lower conversion rates with robotic assisted laparoscopy compared to conventional laparoscopy [ 16 , 21 , 22 ], this could not be confirmed in the large randomized ROLARR trial [ 23 ].…”

Benchmarking of abdominal surgery: a study evaluating the HARM score in a European national cohort

“…In a recent study in two Norwegian hospitals, the presence of surgical complications in patient administrative systems was found to have a sensitivity and specificity of 56 and 95 per cent respectively, and 76 and 65 per cent after exclusion of complications present on admission. A medical registry study found a 14·0 per cent rate of major complications after elective colonic cancer surgery in Norway. This corresponds well with the finding of a 20·2 per cent rate of complications with Clavien–Dindo grade III–IV for all gastrointestinal operations.…”