Video-Laparoscopic versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

Abstract

Background: Minimally invasive surgery in obese patients is still challenging, so exploring one more item in this research field ranks among the main goals of this research. We aimed to compare short-term postoperative outcomes of open and video-laparoscopic (VL) approaches in CRC obese patients undergoing colorectal resection. Methods: We performed a retrospective analysis of a surgical database including 138 patients diagnosed with CRC, undergoing VL (n = 87, 63%) and open (n = 51, 37%) colorectal surgery. As a first step, propensity score matching was performed to balance the comparison between the two intervention groups (VL and open) in order to avoid selection bias. The matched sample (N = 98) was used to run further regression models in order to analyze the observed VL surgery advantages in terms of postoperative outcome, focusing on hospitalization and severity of postoperative complications, according to the Clavien–Dindo classification. Results: The study sample was predominantly male (N = 86, 62.3%), and VL was more frequent than open surgery (63% versus 37%). The two subgroup results obtained before and after the propensity score matching showed comparable findings for age, gender, BMI, and tumor staging. The specimen length and postoperative time before discharge were longer in open surgery (OS) patients; the number of harvested lymph nodes was higher than in VL patients as well (p < 0.01). Linear regression models applied separately on the outcomes of interest showed that VL-treated patients had a shorter hospital stay by almost two days and about one point less Clavien–Dindo severity than OS patients on average, given the same exposure to confounding variables. Tumor staging was not found to have a significant role in influencing the short-term outcomes investigated. Conclusion: Comparing open and VL surgery, improved postoperative outcomes were observed for VL surgery in obese patients after surgical resection for CRC. Both postoperative recovery time and Clavien–Dindo severity were better with VL surgery.

Predictors of Long-Term Outcomes of Video-Laparoscopic Versus Open Surgery in Obese Patients with Colorectal Cancer: A Propensity Score Matching Study

“…In a previous case-matched study conducted at our institution [ 7 ], we found that VL surgery correlates with better short-term outcomes, in terms of the degree of complication (one point less according to Clavien-Dindo, on average) and length of stay (almost two days shorter). In contrast, we found that fewer harvested lymph nodes were found for the VL group.…”

“…Postoperative hospitalization time differed significantly between the two groups, either before or after matching, with fewer days for subjects allocated to VL surgery, and the Clavien-Dindo post-operative severity classification system showed no differences across surgery groups. Anyhow, the short-term results of the same sample have been already discussed elsewhere [ 7 ]. Lastly, the observation time, i.e., follow-up, proved to be significantly longer for subjects undergoing VL surgery, predicting better long-term outcomes ( p < 0.01).…”

“…Instead, this is the first study on a series of excess weight patients affected by CRC, reporting a protective effect of VL surgery on overall survival. This unexpected result could be partially related to better immune status and lower cardiorespiratory and general complications experienced in the postoperative course [ 7 ]. On the other hand, the laparoscopic approach seems to have a protective effect on all-cause mortality, especially in frail patients.…”

“…On the other hand, VL compared with open colorectal surgery is recognized as associated with reduced postoperative pain, shorter hospital stay, less disability, and reduced pulmonary dysfunction [ 6 ]. This way, our recent report on obesity phenotypes undergoing CRC surgery further demonstrated the safe and favorable short-term outcome of the minimally invasive approach compared to the open approach when looking at the postoperative length of stay and severity of postoperative complications [ 7 ].…”

The Effect of the Intraoperative Blood Loss and Intraoperative Blood Transfusion on the Short-Term Outcomes and Prognosis of Colorectal Cancer: A Propensity Score Matching Analysis

“…Due to the popularity of laparoscopic surgery and the development of surgical equipment such as electrothermal bipolar activation devices and ultrasound systems, the average intraoperative blood loss (IBL) has decreased ( 6 , 7 ). However, IBL is still a matter of concern during the operation.…”