Analyzing clinical outcomes in laparoscopic right vs. left colectomy in colon cancer patients using the NSQIP database

Abstract

Introduction

Optimization of surgical outcomes after colectomy continues to be actively studied, but most studies group right-sided and left-sided colectomies together. The aim of our study was to determine whether the complication rate differs between right-sided and left-sided colectomies for cancer.

Methods

We identified patients who underwent laparoscopic colectomy for colon cancer between 2005 and 2010 in the American College of Surgeons National Surgical Quality Improvement Program database and stratified cases by right and left side. The two groups were matched using propensity score matching for demographics, previous abdominal surgery, pre-operative chemotherapy and radiotherapy, and pre-operative laboratory data. Outcome measures were: 30-day mortality and morbidity.

Results

We identified 2512 patients who underwent elective laparoscopic colectomy for right-sided or left-sided colon cancer. The two groups were similar in demographics, and pre-operative characteristics. There was no difference in overall morbidity (15% vs. 17.7%; p value<0.08) or 30-day mortality (1.5% vs. 1.5%; p value<0.9) between the two groups. Sub-analysis revealed higher surgical site infection rates (9% vs. 6%; p value<0.04), higher incidence of ureteral injury (0.6% vs. 0.4%; p value<0.04), higher conversion rate to open colectomy (51% vs. 30%; p value<0.01) and a longer hospital length of stay (10.5±4 vs. 7.1±1.3 days; p value<0.02) in patients undergoing laparoscopic left colectomy.

Conclusion

Our study highlights the difference in complications between right-sided and left-sided colectomies for cancer. Further research on outcomes after colectomy should incorporate right vs. left side colon resection as a potential pre-operative risk factor.