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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Vydané v:Annals of surgery Ročník 270; číslo 1; s. 172
Hlavní autori: Vallance, Abigail E, Keller, Deborah S, Hill, James, Braun, Michael, Kuryba, Angela, van der Meulen, Jan, Walker, Kate, Chand, Manish
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 01.07.2019
Predmet:
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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Abstract 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.
AbstractList 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.OBJECTIVETo 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.SUMMARY OF BACKGROUND DATALaparoscopy 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.METHODSPatients 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.RESULTSThere 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.CONCLUSIONThe use of laparoscopic approach in the emergency resection of colorectal cancer is linked to a shorter length of hospital stay and reduced postoperative mortality.
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.
Author Keller, Deborah S
Hill, James
Kuryba, Angela
van der Meulen, Jan
Walker, Kate
Chand, Manish
Braun, Michael
Vallance, Abigail E
Author_xml – sequence: 1
  givenname: Abigail E
  surname: Vallance
  fullname: Vallance, Abigail E
  organization: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
– sequence: 2
  givenname: Deborah S
  surname: Keller
  fullname: Keller, Deborah S
  organization: Department of Surgery and Interventional Sciences, GENIE Centre, University College London, London, UK
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  givenname: James
  surname: Hill
  fullname: Hill, James
  organization: Department of Colorectal Surgery, Manchester Royal Infirmary, Manchester, UK
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  surname: Braun
  fullname: Braun, Michael
  organization: Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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  surname: Kuryba
  fullname: Kuryba, Angela
  organization: Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
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  surname: van der Meulen
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  organization: London School of Hygiene & Tropical Medicine, London, UK
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  givenname: Kate
  surname: Walker
  fullname: Walker, Kate
  organization: London School of Hygiene & Tropical Medicine, London, UK
– sequence: 8
  givenname: Manish
  surname: Chand
  fullname: Chand, Manish
  organization: Department of Surgery and Interventional Sciences, GENIE Centre, University College London, London, UK
BackLink https://www.ncbi.nlm.nih.gov/pubmed/29621034$$D View this record in MEDLINE/PubMed
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SubjectTerms 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
Title Role of Emergency Laparoscopic Colectomy for Colorectal Cancer: A Population-based Study in England
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