Emergent colectomy for colorectal cancer: A comparative analysis of open vs. minimally invasive approach

Published:October 14, 2022DOI:


      • Minimally invasive colectomy approach for CRC is associated with longer operative times compared to open surgical approach in emergent settings.
      • Minimally invasive colectomy approach for CRC is associated with lower 30-day mortality and 30-day complications.
      • Minimally invasive colectomy approach in the emergency setting may have the potential to improve patient outcomes and decrease the burden of healthcare cost.



      Emergent surgery for colorectal cancer (CRC) is associated with higher rates of morbidity and mortality and outcomes differ by surgical approach.


      Our study compares short-term surgical outcomes of patients undergoing emergent colectomy for CRC using the open vs minimally invasive (MIS) approach. We performed a four-year review (2012–2015) of the ACS-NSQIP Colectomy dataset and included all adult patients with CRC who underwent emergent surgical intervention. Patients were stratified into groups based on surgical approach: Open and MIS (including laparoscopic and robotic).


      A total of 1855 (MIS: 279, Open: 1576) patients were included. Outcome measures were operative time, 30-day complications, 30-day readmission, and 30-day mortality. Multivariate Regression analysis was performed. Patients in the open group were more likely to be older (70y vs. 61y, p < 0.01), have higher ASA class, and were less likely to have received mechanical bowel preparation. On univariate analysis, patients in the MIS group had longer operative time (189 ± 41 min vs. 161 ± 69 min, p < 0.01). Patients in the open group had higher rates of mortality (6.7% vs. 3.8%, p < 0.01) and 30-day complications (28.1% vs. 16.7%, p < 0.01). On regression analysis, the open approach was independently associated with higher odds of 30-day mortality and 30-day complications.


      Given the lower overall mortality and complications, MIS colectomy may be a safer approach in the emergent treatment of patients with colorectal cancer.


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        • Bray F.
        • Ferlay J.
        • Soerjomataram I.
        • Siegel R.L.
        • Torre L.A.
        • Jemal A.
        Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA A Cancer J Clin. 2018; 68: 394-424
        • Hamidi M.
        • Hanna K.
        • Omesiete P.
        • et al.
        Does it matter where you get your surgery for colorectal cancer?.
        Int J Colorectal Dis. 2019; 34 (2019;34(12)): 2121-2127
      1. Colorectal cancer — cancer stat facts.
        • Papageorge C.M.
        • Zhao Q.
        • Foley E.F.
        • et al.
        Short-term outcomes of minimally invasive versus open colectomy for colon cancer.
        J Surg Res. 2016; 204: 83-93
        • Harji D.P.
        • Griffiths B.
        • Burke D.
        • Sagar P.M.
        Systematic review of emergency laparoscopic colorectal resection.
        Br J Surg. 2013; 101: e126-e133
        • Abraha I.
        • Binda G.A.
        • Montedori A.
        • Arezzo A.
        • Cirocchi R.
        • Group C.C.C.
        Laparoscopic versus open resection for sigmoid diverticulitis.
        Cochrane Database Syst Rev. 2017; 2017
        • Oh N.H.
        • Kim K.J.
        Outcomes and risk factors affecting mortality in patients who underwent colorectal emergency surgery.
        Annal Coloproctol. 2016; 32: 133
        • Power E.
        • Simon A.
        • Juszczyk D.
        • Hiom S.
        • Wardle J.
        Assessing awareness of colorectal cancer symptoms: measure development and results from a population survey in the UK.
        BMC Cancer. 2011; 11: 366
        • Ghanadi K.
        • Anbari K.
        • Obeidavi Z.
        • Pournia Y.
        Characteristics of colorectal cancer in khorramabad, Iran during 2013.
        Middle East J Digest Dis. 2014; 6 (/pmc/articles/PMC4034668/): 81
        Date accessed: August 15, 2021
        • Lohsiriwat V.
        Enhanced recovery after surgery vs conventional care in emergency colorectal surgery.
        World J Gastroenterol : WJG. 2014; 2013950
        • Scott N.A.
        • Jeacock J.
        • Kingston R.D.
        Risk factors in patients presenting as an emergency with colorectal cancer.
        Br J Surg. 2005; 82: 321-323
        • Merkel S.
        • Meyer C.
        • Papadopoulos T.
        • Meyer T.
        • Hohenberger W.
        Der notfalleingriff beim kolonkarzinom.
        Zentralblatt für Chirurgie. 2007; 132 (01): 16-25
        • R S
        • T F
        • Po N.
        Primary versus staged resection for acute obstructing colorectal carcinoma.
        Br J Surg. 1992; 79: 685-688
        • Kingston R.D.
        • Walsh S.H.
        • Jeacock J.
        Physical status is the principal determinant of outcome after emergency admission of patients with colorectal cancer.
        Ann R Coll Surg Engl. 1993; 75 (/pmc/articles/PMC2497987/?report=abstract): 335
        Date accessed: August 15, 2021
        • Baer C.
        • Menon R.
        • Bastawrous S.
        • Bastawrous A.
        Emergency presentations of colorectal cancer.
        Surg Clin. 2017; 97: 529-545
        • Ghadban T.
        • Reeh M.
        • Bockhorn M.
        • et al.
        Minimally invasive surgery for colorectal cancer remains underutilized in Germany despite its nationwide application over the last decade.
        Sci Rep. 2018; 8 (2018 8:1): 1-7
        • Felli E.
        • Brunetti F.
        • Disabato M.
        • Salloum C.
        • Azoulay D.
        • de'Angelis N.
        Robotic right colectomy for hemorrhagic right colon cancer: a case report and review of the literature of minimally invasive urgent colectomy.
        World J Emerg Surg : WJES. 2014; 9: 32
        • Schwenk W.
        • Haase O.
        • Neudecker J.J.
        • Müller J.M.
        Short term benefits for laparoscopic colorectal resection.
        Cochrane Database Syst Rev. 2005; (2)
        • Cheng H.
        • Clymer J.W.
        • Po-Han Chen B.
        • et al.
        Prolonged operative duration is associated with complications: a systematic review and meta-analysis.
        J Surg Res. 2018; 229: 134-144
        • Odermatt M.
        • Miskovic D.
        • Siddiqi N.
        • Khan J.
        • Parvaiz A.
        Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study.
        World J Surg. 2013; 37: 2458-2467
      2. Kim YW, Kim IY, Kim BR. Outcomes of Laparoscopic and Open Surgery for Colorectal Cancer in the Emergency Setting.

        • Esparza Monzavi C.A.
        • Naffouje S.A.
        • Chaudhry V.
        • Nordenstam J.
        • Mellgren A.
        • Gantt G.
        Open vs minimally invasive approach for emergent colectomy in perforated diverticulitis.
        Dis Colon Rectum. 2021; : 319-327
        • Osagiede O.
        • Spaulding A.C.
        • Cochuyt J.J.
        • et al.
        Factors associated with minimally invasive surgery for colorectal cancer in emergency settings.
        J Surg Res. 2019; 243: 75-82