Title

Right Colon Resection for Colon Cancer: Does Surgical Approach Matter?

Document Type

Journal Article

Publication Date

10-1-2018

Journal

Journal of Laparoendoscopic and Advanced Surgical Techniques

Volume

28

Issue

10

DOI

10.1089/lap.2018.0148

Keywords

Colon cancer; minimally invasive surgery; morbidity; mortality; right colon resection

Abstract

© 2018, Mary Ann Liebert, Inc. Background: Surgical resection with curative intent remains the standard of care for colon cancer. This study aims to compare the 30-day outcomes and oncologic results following open, laparoscopic, and robot-assisted right colon resection for colon cancer using the Targeted Colectomy American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Materials and Methods: All patients undergoing elective, right colon resection with primary anastomosis were identified within the targeted colectomy ACS-NSQIP database. Only patients with stage I, II, or III colon cancer were included. The association of surgical approach with oncologic results and 30-day morbidity and mortality outcomes was investigated using a variety of statistical tests. Results: A total of 3518 patients met inclusion criteria; 1024 (29.1%) underwent open surgery (OS), 2405 (63.4%) underwent laparoscopic surgery, and 89 (2.5%) underwent robotic surgery. Patients undergoing OS were significantly more likely to have positive resection margins (P <.001). Patients undergoing OS were significantly more likely to experience prolonged intubation (P =.02), deep wound infections (P =.001), wound dehiscence (P =.005), deep venous thrombosis (P =.04), bleeding requiring a blood transfusion (P <.001), a prolonged postoperative ileus (P <.001), and longer length of hospital stay (P <.001), and were more likely to die (P =.02). Conclusion: The laparoscopic approach to colon resection for colon cancer has lower 30-day morbidity compared to OS. The robotic approach is equivalent to the laparoscopic approach, and its utilization may increase in the future.

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