Highlights
- •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.
Abstract
Introduction
Emergent surgery for colorectal cancer (CRC) is associated with higher rates of morbidity
and mortality and outcomes differ by surgical approach.
Methods
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).
Results
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.
Conclusion
Given the lower overall mortality and complications, MIS colectomy may be a safer
approach in the emergent treatment of patients with colorectal cancer.
Keywords
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Article info
Publication history
Published online: October 14, 2022
Accepted:
October 11,
2022
Received in revised form:
September 8,
2022
Received:
May 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
