AB039. 175. The impact of laparoscopic converted to open colectomy on short term and oncologic outcomes for colon cancer

Purpose. This study aimed at evaluating the impact of comorbid diabetes on short-term postoperative outcomes in patients with stage I/II colon cancer after open colectomy. Methods. The data were extracted from the National Inpatient Sample database (2005-2010). Short-term surgical outcomes included in-hospital mortality, postoperative complications, and hospital length of stay. Results. A total of 49,064 stage I/II colon cancer patients undergoing open surgery were included, with a mean age of 70.35 years. Of them, 21.94% had comorbid diabetes. Multivariable analyses revealed that comorbid diabetes was significantly associated with a lower risk of in-hospital mortality and postoperative complications. Compared to patients without diabetes, patients with uncomplicated diabetes had lower percentages of in-hospital mortality and postoperative complications, but patients with complicated diabetes had a higher percentage of postoperative complications. In addition, patients with diabetes only, but not patients with diabetes and hypertension only, had a lower percentage of in-hospital mortality than patients without any comorbidity. Conclusion. The present results suggested the protective effects of uncomplicated diabetes on short-term surgical outcomes in stage I/II colon cancer patients after open colectomy. Further studies are warranted to confirm these unexpected findings and investigate the possible underlying mechanisms.

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Utilization of minimally invasive versus open colectomy for colon cancer and perioperative/short-term oncologic outcomes: Are we there yet?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.733 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 733-733

Author(s):

Jillian K. Smith ◽

Nestor F. Esnaola

Keyword(s):

Colon Cancer ◽

Minimally Invasive ◽

Surgical Approach ◽

Underserved Populations ◽

Surgical Care ◽

Open Colectomy ◽

Oncologic Outcomes ◽

Short Term ◽

Regional Lymph Nodes ◽

Cancer Data

733 Background: Randomized controlled trials (RCTs) in highly-selected patient populations demonstrated equivalent outcomes following minimally invasive colectomy (MIC) versus (vs) open colectomy (OC) for colon cancer. The purpose of this study was to evaluate utilization of MIC and compare perioperative/short-term oncologic outcomes after MIC vs OC in a large, generalizable, national sample. Methods: We identified adult patients with invasive colon adenocarcinoma who underwent elective surgical resection between 2010 and 2012 using the National Cancer Data Base. Univariate associations between patient/tumor/facility/treatment characteristics and surgical approach were analyzed using chi-square tests. Multivariable logistic regression was used to identify independent predictors of receipt of MIC, as well as to evaluate independent associations between surgical approach and outcomes. Results: Among 111,372 patients identified, 48,393 (43.5%) underwent MIC; the proportion who underwent MIC increased between 2010 (37.8%) and 2012 (49%; p < 0.001). High education level (adjusted odds ratio [aOR] 1.13) and increasing income level (aOR 1.09-1.36) were independently associated with receipt of MIC, whereas black race (aOR 0.85), Medicare (aOR 0.86)/Medicaid (aOR 0.67)/uninsured status (aOR 0.57), non-metropolitan residence (aOR 0.92), and community (aOR 0.63) or other (aOR 0.58) cancer programs were independently associated with potential underuse. Mean length of stay was shorter following MIC vs OC (6.07 vs 7.68 days; p < 0.001). Use of MIC was independently associated with reduced 30-day (aOR 0.6) and 90-day (aOR 0.62) mortality, as well as lower rate of positive surgical margins (aOR 0.69) and higher rate of regional lymph nodes examined > = 12 (aOR 1.14). Conclusions: This study confirms that MIC is associated with favorable perioperative/short-term oncologic outcomes (compared to OC), as demonstrated in RCTs. Although utilization of MIC for colon cancer continues to rise, implementation studies are warranted to enhance access to optimal surgical care and eradicate persistent disparities in receipt of MIC among historically underserved populations.

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Allogeneic Leukocyte-Reduced Red Blood Cell Transfusion Is Associated with Postoperative Infectious Complications and Cancer Recurrence after Colon Cancer Resection

Digestive Surgery ◽

10.1159/000498865 ◽

2019 ◽

Vol 37 (2) ◽

pp. 163-170 ◽

Cited By ~ 1

Author(s):

Andrew-Paul Deeb ◽

Christopher T. Aquina ◽

John R.T. Monson ◽

Neil Blumberg ◽

Adan Z. Becerra ◽

...

Keyword(s):

Colon Cancer ◽

Blood Cell ◽

Red Blood Cell ◽

Cancer Recurrence ◽

Infectious Complications ◽

Oncologic Outcomes ◽

Red Blood Cell Transfusion ◽

Elective Resection ◽

Increased Risk ◽

The Impact

Background/Aims: Transfusion rates in colon cancer surgery are traditionally very high. Allogeneic red blood cell (RBC) transfusions are reported to induce immunomodulation that contributes to infectious morbidity and adverse oncologic outcomes. In an effort to attenuate these effects, the study institution implemented a universal leukocyte reduction protocol. The purpose of this study was to examine the impact of leukocyte-reduced (LR) transfusions on postoperative infectious complications, recurrence-free survival, and overall survival (OS). Methods: In a retrospective study, patients with stage I–III adenocarcinoma of the colon from 2003 to 2010 who underwent elective resection were studied. The primary outcome measures were postoperative infectious complications and recurrence-free and OS in patients that received a transfusion. Bivariate and multivariable regression analyses were performed for each endpoint. Results: Of 294 patients, 66 (22%) received a LR RBC transfusion. After adjustment, transfusion of LR RBCs was found to be independently associated with increased infectious complications (OR 3.10, 95% CI 1.24–7.73), increased odds of cancer recurrence (hazard ratio [HR] 3.74, 95% CI 1.94–7.21), and reduced OS when ≥3 units were administered (HR 2.24, 95% CI 1.12–4.48). Conclusion: Transfusion of LR RBCs is associated with an increased risk of infectious complications and worsened survival after elective surgery for colon cancer, irrespective of leukocyte reduction.

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Short‐term and long‐term outcomes of laparoscopic colectomy with multivisceral resection for surgical T4b colon cancer: Comparison with open colectomy

Annals of Gastroenterological Surgery ◽

10.1002/ags3.12372 ◽

2020 ◽

Vol 4 (6) ◽

pp. 676-683 ◽

Cited By ~ 1

Author(s):

Masaaki Miyo ◽

Takeshi Kato ◽

Yusuke Takahashi ◽

Masakazu Miyake ◽

Reishi Toshiyama ◽

...

Keyword(s):

Colon Cancer ◽

Laparoscopic Colectomy ◽

Multivisceral Resection ◽

Open Colectomy ◽

Long Term Outcomes ◽

Short Term

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Minimally Invasive Surgery of Rectal Cancer: Current Evidence and Options

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2012.32.41 ◽

2012 ◽

pp. 214-218 ◽

Cited By ~ 2

Author(s):

Atthaphorn Trakarnsanga ◽

Martin R. Weiser

Keyword(s):

Rectal Cancer ◽

Colon Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Oncologic Outcomes ◽

Current Status ◽

Current Evidence ◽

Short Term ◽

Invasive Approach

Overview: Minimally invasive surgery (MIS) of colorectal cancer has become more popular in the past two decades. Laparoscopic colectomy has been accepted as an alternative standard approach in colon cancer, with comparable oncologic outcomes and several better short-term outcomes compared to open surgery. Unlike the treatment for colon cancer, however, the minimally invasive approach in rectal cancer has not been established. In this article, we summarize the current status of MIS for rectal cancer and explore the various technical options.

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259. The impact of perioperative hemotransfusions on short-term outcomes after surgical treatment of colon cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.08.251 ◽

2014 ◽

Vol 40 (11) ◽

pp. S105

Author(s):

I. Shchepotin ◽

O. Kolesnik ◽

A. Lukashenko ◽

D. Mahmudov ◽

V. Prymak ◽

...

Keyword(s):

Colon Cancer ◽

Surgical Treatment ◽

Short Term ◽

The Impact

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Laparoscopic Colectomy for Colon Cancer - A Trial Update

Swiss Surgery ◽

10.1024/1023-9332.7.6.248 ◽

2001 ◽

Vol 7 (6) ◽

pp. 248-251 ◽

Cited By ~ 11

Author(s):

Nelson

Keyword(s):

Quality Of Life ◽

Colon Cancer ◽

Laparoscopic Colectomy ◽

Disease Free Survival ◽

Extent Of Resection ◽

Open Colectomy ◽

The Mean ◽

Laparoscopic Assisted ◽

The Impact

Objectives:A prospective randomized trial was designed to test the hypothesis that disease-free survival and overall survival are equivalent regardless of whether patients receive laparoscopic assisted colectomy (LAC) or open colectomy. Secondary and tertiary aims will test the safety of LAC and the impact of LAC on quality of life and costs, respectively. Methods:1200 patients will be accrued and randomly assigned to LAC or open colectomy. Consenting adults with primary colon cancer without previous or concurrent malignancies and with tumors considered resectable for cure are eligible for enrollment. Patients will be followed postoperatively for evidence of recurrence and for survival and perioperatively for morbidity, mortality, quality of life, and cost end points. Results: Over 800 patients have been enrolled to date. Early trial results are available for 408 patients, 203 open and 205 LAC. As anticipated, patients are evenly distributed within the two treatment arms according to age, gender, and anesthesia risk (ASA classification). In the open arm, the mean age is 69 with 52 percent females, 87 percent ASA I/II and 13 percent ASA III. In the laparoscopic arm, the mean age is 67, with 48 percent females, 87 percent ASA I/II, and 13 percent ASA III. A total of 160 right and 117 sigmoid colectomies have been performed. Extent of resection data is also available and all parameters tested show no difference between the LAC and open cases: for the laparoscopic vs open colectomy, total bowel length 26cm vs 27cm; proximal margins 12cm vs 11cm; distal margins 10cm vs 12cm; mesenteric length 9cm vs 8cm. Similarly, the number of nodes resected for laparoscopic colectomy is essentially the same (mean 12 lymph nodes) to that for open surgery (mean 13 nodes). Conclusions: Although this study is ongoing; preliminary results suggest that open and LAC provide for the same extent of resection. The quality of life portion of the study is now complete and data will soon be available.

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Nodal retrieval and short-term outcomes of robotic and laparoscopic colectomies for colon cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.713 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 713-713 ◽

Cited By ~ 1

Author(s):

Trang Nguyen ◽

Stacey Stern ◽

Ahmed Dehal ◽

Brooke Vuong ◽

Anton J. Bilchik

Keyword(s):

Colon Cancer ◽

High Volume ◽

Oncologic Outcomes ◽

Perioperative Outcomes ◽

National Database ◽

Community Hospitals ◽

Short Term ◽

Open Operation ◽

Academic Hospitals ◽

Low Volume

713 Background: It is debatable whether robotic colectomies is advantageous over laparoscopic colectomies for colon cancer (CC). We aim to evaluate oncologic and perioperative outcomes between robotic and laparoscopic colectomies in a national database. Methods: The National Cancer Database was queried from 2010-2014 for patients with resectable (stage I-III) CC. Lymph node (LN) retrieval, length of stay (LOS), perioperative outcomes and OS were analyzed based on type of surgery: right colectomy vs. left colectomy and robotic (ROBO) vs. laparoscopic (LAP). Results: 61,903 patients met inclusion criteria. There was no difference in inadequate LN retrieval (< 12 LN), or short-term mortality between ROBO and LAP groups. There was a significant decrease in conversion to an open operation and LOS for ROBO vs. LAP groups as well as increased 5 year OS (Table). ROBO colectomies increased four-fold over 5 years. About half were done at community hospitals (56%) and at low ROBO volume hospitals (47.2%). Inadequate LN retrieval in the ROBO group was greater at low volume centers (9.2%) compared to high volume centers (12.3%) (p < 0.0001) as well as at community hospitals (12.2%) compared to academic hospitals (8.5%) (p=0.0003). Conclusions: This population analysis showed that robotic colectomies was associated with equivalent short-term outcomes and LN retrieval as laparoscopic colectomies. However, half of robotic colectomies were done at community hospitals or low volume hospitals, where the rate of inadequate LN retrieval was higher than at academic hospitals or high volume centers. As robotic colectomies increases, it is important that technology is implemented judiciously so that oncologic outcomes are not compromised. [Table: see text]

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The Impact of Conversion to Laparotomy in Rectal Cancer

The American Surgeon ◽

10.1177/0003134820933551 ◽

2020 ◽

Vol 86 (7) ◽

pp. 811-818

Author(s):

Salvatore A. Parascandola ◽

Salini Hota ◽

Mayou Martin T. Tampo ◽

Andrew D. Sparks ◽

Vincent Obias

Keyword(s):

Rectal Cancer ◽

Minimally Invasive ◽

Large Population ◽

Oncologic Outcomes ◽

Minimally Invasive Approach ◽

Short Term ◽

Population Database ◽

Invasive Approach ◽

Positive Margins ◽

The Impact

Background Data regarding the effect of conversion from minimally invasive surgery (MIS) to laparotomy in rectal cancer is limited. This study examines the impact of conversion from laparoscopic or robotic-assisted techniques to open resection on oncologic outcomes in a large population database. Methods The National Cancer Database from 2010 to 2016 was reviewed for all cases of invasive adenocarcinoma of the rectum or rectosigmoid junction managed surgically. Patients were divided into 3 cohorts by approach: laparoscopic/robotic (MIS), converted proctectomy (CP), and open proctectomy (OP). Kaplan–Meier estimation was used for unadjusted survival analysis, followed by adjusted multivariable Cox-Proportional Hazards regression. Secondary outcomes were analyzed by multivariable logistic regression. Results The inclusion criteria identified 57 574 patients cases of adenocarcinoma of the rectum managed surgically. Of these patients, 23 579 (41.0%) underwent MIS, 3591 (6.2%) CP, and 30 404 (52.8%) OP. Five-year overall survival was greater in the MIS (70.4%) versus CP and OP (64.4% and 61.4%). No differences were detected for positive margins, 30-day, or 90-day mortality between CP and OP. MIS and CP approaches were significantly associated with increased odds of 12 or more regional lymph nodes examined and decreased overall mortality hazard compared with OP (all respective significant P < .05). Discussion While similar odds of positive margins and short-term mortality is seen in patients whose procedure converts to laparotomy compared with planned laparotomy, both short-term and long-term oncologic benefit is seen in those who undergo a minimally invasive approach. Thus, a minimally invasive approach should be attempted for patients with rectal cancer.

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