Short-term outcomes of laparoscopic approach to colonic obstruction for colon cancer

Abstract

BackgroundWe speculated that a laparoscopic approach to emergent/urgent partial colectomy for colonic obstruction would be associated with less morbidity and shorter length of stay with similar mortality to open colectomy. We compared the outcomes of laparoscopic and open approaches to emergent/urgent partial colectomy for colonic obstruction from colonic cancer using data from the National Surgical Quality Improvement Program (NSQIP) database for the period of 2012-2017. Methods Multivariate analysis compared NSQIP data points following laparoscopic, laparoscopic converted to open, and open colectomy for emergent/urgent colectomy for colonic obstruction from colon cancer from 2012 to 2017.Results A total of 1293 patients who underwent emergent colectomy for colon obstruction from colon cancer during 2012-2017 were identified within the NSQIP database. Laparoscopic approach was used for colonic obstruction in 19.3% of operations with a conversion rate of 28.5%. A laparoscopic approach to obstructing colonic cancers was associated with lower morbidity (50% vs. 61.8%, AOR: 0.67, P = 0.01) and shorter hospitalization length (10 days vs. 13 days, mean difference: 3 days, P < 0.01) compared with an open approach. However, the mean operation duration was longer in laparoscopic operations than open operations (159 min vs. 137 min, P < 0.01). ConclusionA laparoscopic approach to malignant colonic obstruction is associated with decreased morbidity. This suggests that efforts should be directed towards increasing the utilization of laparoscopic approaches for the surgical treatment of colonic obstruction.

Short- and Long-term Outcomes After Laparoscopic Emergency Resection of Left-Sided Obstructive Colon Cancer: A Nationwide Propensity Score–Matched Analysis

“…Our results are in line with a recent American nationwide retrospective cohort study of 1293 acutely treated colon cancer patients that also found significantly lower morbidity (50% vs 61.8%) and shorter length of stay. 8 Yet, we are the first to show an association between surgical approach in the emergency setting and survival. Few studies investigated long-term oncological outcomes after colon cancer surgery in this setting.…”

“…There are various previously conducted observational studies that compared postoperative outcomes after open and laparoscopic colon cancer surgery in the emergency setting. [8][9][10][11][12] However, little evidence exists on emergency laparoscopic resection of LSOCC specifically, and none were able to sufficiently investigate long-term outcomes. Therefore, we sought to investigate the role of laparoscopic versus open emergency resection of LSOCC with regard to short-term and long-term outcomes in a population-based cohort by using propensity score matching.…”

Early Experience of Laparoscopic Colonic Surgery and its Associated Factors

“…Colonic resection has progressed throughout the years. In the 1960s, Turnbull et colleagues proposed the "no-touch" approach for colonic cancer, which advocated early closure of mesocolic arteries and atraumatic manipulation of the tumour to prevent cells from spreading 11 . In an experimental investigation, Eggermont et colleagues proved the importance of decreasing surgical trauma in cancer patients.…”

Comparing the short-term results of the improved triangular anastomosis technique for complete laparoscopic radical resection of sigmoid colon cancer and laparoscopic-assisted small incision colon reconstruction: A CONSORT study

“…The incision is used to take out the surgical specimen immediately, which greatly reduces the surgical incision, makes the abdominal cavity exposure time shorter, and effectively improves the patient’s postoperative recovery speed. [ 18 , 19 ] Triangular anastomosis is a new clinical technique for complete laparoscopic reconstruction of the digestive tract. It refers to the application of a linear cutting stapler to complete the functional end-to-end anastomosis of the remnant stomach and the posterior wall of the duodenum.…”