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Risk Factors for Compromised Surgical Resection

A Nationwide Propensity Score-Matched Study on Laparoscopic and Open Resection for Colonic Cancer

Vogelsang, Rasmus P. M.D.1; Klein, Mads F. M.D., Ph.D.2,3; Gögenur, Ismail M.D., D.M.Sc.1,3,4

Diseases of the Colon & Rectum: April 2019 - Volume 62 - Issue 4 - p 438–446
doi: 10.1097/DCR.0000000000001304
Original Contributions: Colorectal Cancer
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BACKGROUND: High-quality surgical resection of colonic cancer, including dissection along the embryologic mesocolic plane, translates into improved long-term oncological outcomes.

OBJECTIVE: This study aimed to identify risk factors for compromised specimen quality and to evaluate the specimen quality of patients undergoing laparoscopic and open resection for colonic cancer.

DESIGN: This is a retrospective observational study.

SETTINGS: This database study is based on the prospective national Danish Colorectal Cancer Database including patients undergoing intended curative elective colonic cancer surgery from January 1, 2010 through December 2013.

PATIENTS: A total of 5143 patients (1602 open resections; 3541 laparoscopic resections) with colonic cancer were included.

MAIN OUTCOME MEASURES: Risk factors for poor resection quality were identified through uni- and multivariate logistic regression analysis. The surgical approach was assessed by propensity score-matched regression analysis. Poor resection quality was defined as resections in the muscularis plane accompanied by R0 resection, or resections in any resection plane accompanied by R1 resection.

RESULTS: Overall, 4415 (85.8%) of the resections were considered good and 728 (14.2%) were considered poor. After multivariate analysis, neoadjuvant oncological treatment, advanced tumor stage (T3-4), advancing N stage (N1-2), open tumor perforation, and open surgery significantly increased the risk of poor resection quality. In a propensity score-matched sample (n = 1508 matched pairs), matched for age, sex, ASA score, BMI, neoadjuvant treatment, tumor stage, and tumor location, open resection was still associated with a higher risk of poor resection quality compared with laparoscopic resection (OR, 1.4; 95% CI, 1.1–1.8; p = 0.002).

LIMITATIONS: Retrospective design was a limitation of this study.

CONCLUSIONS: In this nationwide propensity score-matched database study, laparoscopic resection was associated with a higher probability of good resection quality compared with open resection for colonic cancer. Risk factors for compromised specimen quality were neoadjuvant oncological treatment, locally advanced tumor stage (T3-4), advanced N stage (N1-2), open tumor perforation, and open surgery. See Video Abstract at http://links.lww.com/DCR/A830.

1 Zealand University Hospital, Center for Surgical Science, Department of Surgery, Roskilde, Denmark

2 Copenhagen University Hospital Herlev, Center for Minimally Invasive and Robotic Surgery, Department of Surgery, Herlev, Denmark

3 Danish Colorectal Cancer Group (DCCG), Denmark

4 University of Copenhagen, Department of Clinical Medicine, Copenhagen N, Denmark

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Support/Funding: None reported.

Financial Disclosure: None reported.

Presented at the meeting of the European Society of Coloproctology, Milan, Italy, September 27 to 30, 2016.

Correspondence: Rasmus Peuliche Vogelsang, M.D., Zealand University Hospital, Center for Surgical Science, Department of Surgery, Sygehusvej 10, DK-4000 Roskilde, Denmark. E-mail: rvo@regionsjaelland.dk

© 2019 The American Society of Colon and Rectal Surgeons