The following is a summary of “Short- and Long-term Outcomes After Laparoscopic Emergency Resection of Left-Sided Obstructive Colon Cancer: A Nationwide Propensity Score–Matched Analysis,” published in the June 2023 issue of Diseases of the Colon and Rectum by Zwanenburg et al.
The role of laparoscopy in the emergency resection of left-sided obstructive colon cancer remains uncertain, particularly regarding its effect on survival. This study sought to evaluate the short- and long-term outcomes following laparoscopic versus open emergency resection of left-sided obstructive colon cancer. This observational cohort study compared patients who underwent laparoscopic emergency resection and those who underwent open emergency resection from 2009 to 2016. The comparison was made using a 1:3 propensity-score matching approach. The variables that were considered for matching included sex, age, BMI (Body Mass Index), ASA score (American Society of Anesthesiologists score), previous abdominal surgery, tumor location, cT4 (clinical T4 stage), cM1 (clinical M1 stage), multi-visceral resection, small-bowel distention on CT (computed tomography), and subtotal colectomy.
Out of 2,002 eligible patients diagnosed with left-sided obstructive colon cancer, 158 patients who received laparoscopic emergency resection were compared to 474 patients who received open emergency resection. The primary outcome measures included 90-day mortality, 90-day complications, permanent stoma formation, disease recurrence, overall survival, and disease-free survival. The deliberate implementation of laparoscopy led to a notable reduction in complications within 90 days (26.6% vs. 38.4%; conditional odds ratio, 0.59; 95% CI, 0.39–0.87) while maintaining a comparable 90-day mortality rate. The laparoscopic procedure yielded superior 3-year overall survival rates (81.0% compared to 69.4%; hazard ratio [HR], 0.54; 95% CI, 0.37–0.79) and disease-free survival rates (68.3% compared to 52.3%; HR, 0.64; 95% CI, 0.47–0.87). Multivariable regression analyses of the unmatched 2002 patients revealed a significant independent correlation between laparoscopy.
A reduced incidence of 90-day complications as well as improved 3-year survival outcomes. The limitation of selection bias cannot be eliminated due to the retrospective nature of this study. This study, conducted on a population basis, utilizing propensity score-matched analysis, indicates that deliberate laparoscopic emergency resection may enhance outcomes in individuals diagnosed with left-sided obstructive colon cancer compared to open emergency resection. The management of these patients in the emergency setting necessitates careful consideration for intentional laparoscopic resection if appropriate expertise is accessible. Exploring other alternatives, such as decompressing stoma, is essential to avoid the need for open emergency resection.
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