Traditional surgical dogma recommends quick open operations to “get them off the table” rather than more time-consuming, minimally invasive surgery for high-risk patients. Patients with high-risk colon cancer were randomly assigned to undergo a shorter open operation or a longer minimally invasive surgery. Research design: a retrospective cohort study with subsequent comparisons. Medical centers that were part of the national surgical database were the ones where the interventions took place. Patients with ASA class 3 or 4 colon cancer who underwent right or sigmoid colectomy between 2012 and 2017 were identified using the National Surgical Quality Improvement Program database. Roughly 30 days after surgery, patients in short open and the long minimally invasive groups were compared for their outcomes. There were 3,774 patients who had long minimally invasive right colectomy or short open right colitectomies (33% open, 67% minimally invasive surgery P<0.05), and 1,042 patients who had long minimally invasive sigmoid colitectomies or short open sigmoid colectomies (36% open, 64% minimally invasive surgery P<0.05). The study’s retrospective design and reliance on predetermined metrics for success both acted as constraints. The outcomes of high-risk patients undergoing colectomy for colon cancer were worse with shorter open procedures than with longer minimally invasive ones. High-risk patients need to have minimally invasive surgery that takes longer but is safer.
