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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

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

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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:

© 2019 The American Society of Colon and Rectal Surgeons