Role of Emergency Laparoscopic Colectomy for Colorectal Cancer: A Population-based Study in England

To evaluate factors associated with the use of laparoscopic surgery and the associated postoperative outcomes for urgent or emergency resection of colorectal cancer in the English National Health Service. Laparoscopy is increasingly used for elective colorectal cancer surgery, but uptake has been li...

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Vydáno v:Annals of surgery Ročník 270; číslo 1; s. 172
Hlavní autoři: Vallance, Abigail E, Keller, Deborah S, Hill, James, Braun, Michael, Kuryba, Angela, van der Meulen, Jan, Walker, Kate, Chand, Manish
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 01.07.2019
Témata:
Adolescent
Adult
Colectomy - methods
Colectomy - statistics & numerical data
Colorectal Neoplasms - surgery
Databases, Factual
Emergencies
England
Female
Humans
Laparoscopy - statistics & numerical data
Logistic Models
Male
Middle Aged
Practice Patterns, Physicians' - statistics & numerical data
Procedures and Techniques Utilization - statistics & numerical data
State Medicine
Young Adult
England
ISSN:1528-1140, 1528-1140
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Shrnutí:To evaluate factors associated with the use of laparoscopic surgery and the associated postoperative outcomes for urgent or emergency resection of colorectal cancer in the English National Health Service. Laparoscopy is increasingly used for elective colorectal cancer surgery, but uptake has been limited in the emergency setting. Patients recorded in the National Bowel Cancer Audit who underwent urgent or emergency colorectal cancer resection between April 2010 and March 2016 were included. A multivariable multilevel logistic regression model was used to estimate odds ratios (ORs) of undergoing laparoscopic resection and postoperative outcome according to approach. There were 15,516 patients included. Laparoscopy use doubled from 15.1% in 2010 to 30.2% in 2016. Laparoscopy was less common in patients with poorer physical status [American Society of Anaesthesiologists (ASA) 4/5 vs 1, OR 0.29 (95% confidence interval, 95% CI 0.23-0.37), P < 0.001] and more advanced T-stage [T4 vs T0-T2, OR 0.28 (0.23-0.34), P < 0.001] and M-stage [M1 vs M0, OR 0.85 (0.75-0.96), P < 0.001]. Age, socioeconomic deprivation, nodal stage, hospital volume, and a dedicated colorectal emergency service were not associated with laparoscopy. Laparoscopic patients had a shorter length of stay [median 8 days (interquartile range (IQR) 5 to 15) vs 12 (IQR 8 to 21), adjusted mean difference -3.67 (-4.60 to 2.74), P < 0.001], and lower 90-day mortality [8.1% vs 13.0%; adjusted OR 0.78 (0.66-0.91), P = 0.004] than patients undergoing open resection. There was no significant difference in rates of readmission or reoperation by approach. The use of laparoscopic approach in the emergency resection of colorectal cancer is linked to a shorter length of hospital stay and reduced postoperative mortality.
Bibliografie:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ISSN:1528-1140
1528-1140
DOI:10.1097/SLA.0000000000002752