Laparoscopic versus Open Emergency Surgery for Right Colon Cancers
Abstract
:1. Introduction
2. Method
2.1. Study Population
2.2. Surgical Technique
2.3. Pathological Report
2.4. Postoperative Outcomes and Follow-up
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Operative Outcomes
3.3. Pathologic Results
3.4. Postoperative course
3.5. Oncological Prognosis
3.6. Prognostic Factors
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 202) | Open (n = 114) | Laparoscopic (n = 88) | p | |
---|---|---|---|---|
Age, years | 74.0 (63.0–81.0) | 76.0 (64.0–81.2) | 71.0 (59.5–80.0) | 0.137 |
Male sex (%) | 85 (42.1%) | 41 (36.0%) | 44 (50.0%) | 0.045 |
BMI, Kg/m2 | 24.0 (21.9–28.0) | 24.0 (21.3–28.0) | 24.0 (22.0–28.0) | 0.709 |
ASA | 0.060 | |||
I | 12 (5.9%) | 6 (5.3%) | 6 (6.8%) | |
II | 68 (33.7%) | 30 (26.3%) | 38 (43.2%) | |
III | 57 (28.2%) | 34 (29.8%) | 23 (26.1%) | |
IV | 11 (5.4%) | 9 (7.9%) | 2 (2.3%) | |
Missing data | 54 (26.7%) | 35 (30.7%) | 19 (21.6%) | |
Tumour site | 0.012 | |||
Caecum | 92 (45.5%) | 52 (45.6%) | 40 (45.5%) | |
Ascending colon | 35 (17.3%) | 17 (14.9%) | 18 (20.5%) | |
Hepatic flexure | 31 (15.3%) | 12 (10.5%) | 19 (21.6%) | |
Transverse colon | 44 (21.8%) | 33 (28.9%) | 11 (12.5%) | |
Type of surgery | 0.031 | |||
Right hemicolectomy | 150 (74.3%) | 78 (68.4%) | 72 (81.8%) | |
Extended right hemicolectomy | 52 (25.7%) | 36 (31.6%) | 16 (18.2%) | |
Operative time, min | 180.0 (136.5–226.0) | 156.0 (123.7–211.5) | 203 (161.7–242.2) | <0.001 |
Conversion rate (%) | / | / | 13 (14.8%) | / |
LN yield, n | 19.0 (15.0–26.0) | 18.0 (13.0–22.0) | 22.0 (17.0–30.0) | <0.001 |
pT | 0.339 | |||
1 | 1 (0.5%) | 1 (0.9%) | 0 | |
2 | 8 (4.0%) | 5 (4.4%) | 3 (3.4%) | |
3 | 81 (40.1%) | 40 (35.1%) | 41 (46.6%) | |
4 | 112 (55.4%) | 68 (59.6%) | 44 (50.0%) | |
pN | 0.341 | |||
0 | 78 (38.6%) | 48 (42.1%) | 30 (34.1%) | |
1 | 55 (27.2%) | 27 (23.7%) | 28 (31.8%) | |
2 | 69 (34.2%) | 39 (34.2%) | 30 (34.1%) | |
pM+ | 22 (10.9%) | 14 (12.3%) | 8 (9.1%) | 0.471 |
pTNM staging | 0.513 | |||
1 | 9 (4.5%) | 6 (5.3%) | 3 (3.4%) | |
2 | 68 (33.7%) | 41 (36.0%) | 27 (30.7%) | |
3 | 103 (51.0%) | 53 (46.5%) | 50 (56.8%) | |
4 | 22 (10.9%) | 14 (12.3%) | 8 (9.1%) | |
R grade | 0.049 | |||
0 | 167 (82.7%) | 90 (78.9%) | 79 (87.5%) | |
1 | 20 (9.9%) | 11 (9.6%) | 9 (10.2%) | |
2 | 15 (7.4%) | 13 (11.4%) | 2 (2.3%) |
Total (n = 202) | Open (n = 114) | Laparoscopic (n = 88) | p | |
Postoperative stay, days | 10.0 (7.0–18.0) | 12.5 (8.0–21.0) | 8.0 (5.0–13.7) | <0.001 |
30d Complication | 77 (38.1%) | 45 (39.5%) | 32 (36.4%) | 0.652 |
Clavien–Dindo | 0.454 | |||
II | 46 (59.7%) | 28 (62.2%) | 18 (56.2%) | |
III | 12 (15.6%) | 8 (17.8%) | 4 (12.5%) | |
IV | 5 (6.5%) | 1 (2.2%) | 4 (12.5%) | |
V | 14 (18.2%) | 8 (17.8%) | 6 (18.7%) | |
Anastomotic leak | 4 (2.0%) | 2 (4.6%) | 2 (2.3%) | 1.000 |
Wound infection | 40 (19.8%) | 22 (19.3%) | 18 (20.5%) | 0.838 |
Ileus | 18 (8.9%) | 9 (7.9%) | 9 (10.2%) | 0.564 |
Reoperation | 12 (5.9%) | 8 (7.0%) | 4 (4.5%) | 0.557 |
Readmission | 10 (5.0%) | 7 (6.1%) | 3 (3.4%) | 0.518 |
Adjuvant chemotherapy, yes | 80 (39.6%) | 36 (31.6%) | 44 (50.0%) | 0.011 |
Adjuvant chemotherapy completion | 64 (80.0%) | 24 (66.7%) | 44 (90.9%) | 0.007 |
Dead in FU | 128 (63.4%) | 85 (74.6%) | 43 (48.9%) | <0.001 |
Follow-up, months | 26.0 (9.0–58.5) | 20.5 (7.7–53.2) | 33.5 (13.2–62.0) | <0.001 |
Recurrence | 71 (35.1%) | 39 (34.2%) | 32 (36.4%) | 0.751 |
Liver | 35 (17.3%) | 20 (17.5%) | 15 (17.0%) | 0.926 |
Lung | 15 (7.4%) | 7 (6.1%) | 8 (9.1%) | 0.428 |
Peritoneal | 28 (13.9%) | 18 (15.8%) | 10 (11.4%) | 0.367 |
Uterus/ovaries | 3 (1.5%) | 3 (2.6%) | 0 | 0.125 |
PALN | 4 (2.0%) | 0 | 4 (4.5%) | 0.021 |
Splenic | 2 (1.0%) | 1 (0.9%) | 1 (1.1%) | 0.854 |
Pelvis | 6 (3.0%) | 2 (1.8%) | 4 (4.5%) | 0.247 |
Anastomotic site/mesentery | 8 (4.0%) | 4 (3.5%) | 4 (4.5%) | 0.708 |
Bone | 4 (2.0%) | 2 (1.8%) | 2 (2.3%) | 0.793 |
Sigmoid | 1 (0.5%) | 1 (0.9%) | 0 | 0.378 |
Univariate | Multivariate | ||||
---|---|---|---|---|---|
HR (95% CI) | p | HR (95% CI) | p | ||
Age, years | <55 | Reference | |||
≥55 | 1.900 (0.964–3.743) | 0.064 | |||
Sex | Female | Reference | |||
Male | 0.741 (0.518–1.058) | 0.099 | |||
BMI, Kg/m2 | <25 | Reference | |||
≥25 | 0.838 (0.550–1.277) | 0.411 | |||
Approach | Lap | 0.556 (0.385–0.803) | 0.002 | 0.449 (0.303–0.666) | <0.001 |
pT | 0–2 | Reference | |||
3–4 | 1.495 (0.611–3.660) | 0.379 | |||
pN | 0 | Reference | |||
1–2 | 2.193 (1.492–3.224) | <0.001 | 1.809 (1.194–2.739) | 0.005 | |
pM | 2.679 (1.653–4.343) | <0.001 | 1.766 (1.080–2.887) | 0.023 | |
Retrieved LN | <12 | Reference | |||
≥12 | 0.591 (0.362–0.963) | 0.035 | 0.434 (0.261–0.723 | 0.001 | |
Stage | 0–II | Reference | |||
III–IV | 2.258 (1.531–3.330) | <0.001 | |||
R stage | 0 | Reference | |||
1–2 | 4.529 (2.940–6.975) | <0.001 | 2.105 (1.369–3.237) | <0.001 | |
Complication | yes | 1.619 (1.141–2.296) | 0.007 | ||
Clavien–Dindo | 0–II | Reference | |||
III–V | 2.941 (1.928–4.487) | <0.001 | 3.508 (2.255–5.455) | <0.001 | |
Adjuvant chemotherapy | yes | 0.856 (0.593–1.235) | 0.406 |
Univariate | Multivariate | ||||
---|---|---|---|---|---|
HR (95% CI) | p | HR (95% CI) | p | ||
Age, years | <55 | Reference | |||
≥55 | 1.287 (0.590–2.810) | 0.526 | |||
Sex | Female | Reference | |||
Male | 0.709 (0.437–1.150) | 0.163 | |||
BMI, Kg/m2 | <25 | Reference | |||
≥25 | 1.205 (0.716–2.028) | 0.482 | |||
Approach | Lap | 0.950 (0.595–1.517) | 0.830 | ||
pT | 0–2 | Reference | |||
3–4 | 2.064 (0.506–8.423) | 0.313 | |||
ypN | 0 | Reference | |||
1–2 | 3.081 (1.757–5.402) | <0.001 | 2.395 (1.352–4.243) | 0.003 | |
Retrieved LN | <12 | Reference | |||
≥12 | 0.837 (0.362–1.936) | 0.678 | |||
Stage | 0–II | Reference | |||
III–IV | 1.252 (0.542–2.891) | 0.599 | |||
R stage | 0 | Reference | |||
1–2 | 2.851 (1.595–5.096) | <0.001 | 2.117 (1.184–3.785) | 0.011 | |
Complication | yes | 1.348 (0.833–2.183) | 0.224 | ||
Clavien–Dindo | 0–II | Reference | |||
III–V | 1.594 (0.809–3.142) | 0.178 | |||
Adjuvant chemotherapy | yes | 1.570 (0.966–2.550) | 0.069 |
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Hussain, M.I.; Piozzi, G.N.; Sakib, N.; Duhoky, R.; Carannante, F.; Khan, J.S. Laparoscopic versus Open Emergency Surgery for Right Colon Cancers. Diagnostics 2024, 14, 407. https://doi.org/10.3390/diagnostics14040407
Hussain MI, Piozzi GN, Sakib N, Duhoky R, Carannante F, Khan JS. Laparoscopic versus Open Emergency Surgery for Right Colon Cancers. Diagnostics. 2024; 14(4):407. https://doi.org/10.3390/diagnostics14040407
Chicago/Turabian StyleHussain, Mohammad Iqbal, Guglielmo Niccolò Piozzi, Najmu Sakib, Rauand Duhoky, Filippo Carannante, and Jim S. Khan. 2024. "Laparoscopic versus Open Emergency Surgery for Right Colon Cancers" Diagnostics 14, no. 4: 407. https://doi.org/10.3390/diagnostics14040407