A comparison of trends in operative approach and postoperative outcomes for colorectal cancer surgery

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• 作者：Jamin K. Addae ; MD ; MPH^a ; ^{jaddae1@jhmi.edu} ; Faiz Gani ; MBBS^a ; Sandy Y. Fang ; MD^a ; Elizabeth C. Wick ; MD^a ; Azah A. Althumairi ; MD^a ; Jonathan E. Efron ; MD^a ; Joseph K. Canner ; MHS^a ; David M. Euhus ; MD^a ; Eric B. Schneider ; PhD^a ; ^b ; ^{eschnei1@jhmi.edu}
• 关键词：Minimally invasive surgery ; Temporal trends ; Length of stay ; Colorectal cancer ; Morbidity ; Costs
• 刊名：Journal of Surgical Research
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：208
• 期：Complete
• 页码：111-120
• 全文大小：693 K
• 卷排序：208

文摘

Data-assessing trends and perioperative outcomes relative to surgical approach for colorectal cancer (CRC) surgery are lacking. We report national trends of CRC surgery and compare postoperative outcomes by surgical approach.MethodsA total of 261,886 patients undergoing surgery for CRC were identified using the Nationwide Inpatient Sample from 2009 to 2012. Trends in surgical approach were assessed using the Cochrane–Armitage test of trends. Multivariable logistic and linear regression analyses were performed to compare length of stay (LOS), postoperative complications, and cost by surgical approach.ResultsAt the time of surgery, 57.5% underwent an open procedure, whereas 42.4% underwent either a laparoscopic (39.9%) or robotic (2.5%) colorectal surgery. The use of minimally invasive surgery increased over time (2009 versus 2012: 37.3% versus 46.8%; P < 0.001). Postoperative morbidity was 15.9% and was higher after open surgery (open versus laparoscopic versus robotic: 18.4% versus 12.4% versus 13.3%; P < 0.001). Patients who underwent a minimally invasive surgery had shorter LOS (laparoscopic: OR, 0.55, 95% CI, 0.52-0.58; robotic: OR, 0.58; 95% CI, 0.49-0.69; both P < 0.001). Robotic surgery was consistently associated with the highest mean costs followed by laparoscopic and open surgery (P < 0.001).ConclusionsPatients undergoing minimally invasive colorectal surgery had a lower postoperative morbidity and shorter LOS compared with patients undergoing open colorectal surgery.