Introduction While the role of laparoscopic surgery (LC) for colorectal cancer (CRC) has evolved for use in the majority of instances, the ability to predict circumstances where it is associated with better or worse outcomes after colectomy will help guide surgeons in the relative choice of the procedure over open surgery (OC) particularly when dealing with patients expected to be at high risk for postoperative complications. This study examines factors that may guide the relative circumstances where either the laparoscopic approach may preferably be indicated or avoided.
Method The National Surgical Quality Improvement Program 2012–2013 database was used to identify patients who underwent LC and OC for the treatment of CRC. First, the 2 surgical groups were compared using Mann Whitney U tests and Chi-square statistics. Next, the relationship between surgery type (LC vs. OC) and postoperative outcomes, classified as either medical or surgical complications, was examined using multivariable logistic models. Any covariates univariately associated with the outcome of interest (Pvalue <0.20) were controlled for in the multivariable model. Lastly, the interaction between each of these covariates and LC/OC was examined to identify risk factors that may make LC or OC more preferable.
Results Of the 24502 patients who underwent surgery for CRC, 11866 (48.4%) underwent LC and 12636 (51.6%) underwent OC. There were significant differences in comorbidities between patients who underwent LC versus OC, with mean BMI, chronic steroid use and neurological disease as the only exceptions. OC patients were more likely to undergo emergency surgery, have ASA class 3/4 instead of ASA 1/2 and undergo proctectomy over colectomy than LC patients. Patients undergoing LC had a lower likelihood of developing any complication compared to OC. When evaluating factors associated with the occurrence of surgical complications, ASA class was the only common independent predictor (Pvalue 0.02). LC was associated with lower complication rates for both ASA class 1/2 and 3/4 patients and was even found to be more protective for class 3/4 (OR 0.52 vs. 0.72). When evaluating the relative benefit of LC over OC concerning medical complications, neurological disease remained the only independent predictor (Pvalue 0.02). Hence, patients with a history of neurological disease undergoing LC were more likely to develop medical complications (OR 1.3) compared to those without a neurological history (OR 0.57).
Conclusion These data suggest that while OC is currently the preferred technique for patients with comorbid conditions, LC confers particular benefits in terms of surgical complications in CRC patients with the most significant comorbid conditions.
Disclosure of interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.