Laparoscopic surgery reduced frequency of postoperative small bowel obstruction, and hospital stay compared with open surgery in a cohort of patients with colorectal cancer: a propensity score matching analysis.

Abstract

BACKGROUND:

Laparoscopic surgery (LS) is reported to reduce postoperative complications and hospital stay compared with open surgery (OP). Because patient selection may have been biased in previous studies, propensity score matching (PSM) analysis was used in this study to test the benefits of LS compared with OP.

METHODS:

A total of 759 patients with stage I-III colorectal cancer undergoing curative surgery were retrospectively reviewed. To minimize confounding bias between LS and OP groups, a 1:1 PSM analysis was performed based on adjuvant chemotherapy, age, albumin, body mass index, American Society of Anesthesiologists physical status depth of tumor, gender, lymph node dissection, maximum tumor size, obstructive tumor, previous abdominal surgery, pathological stage, tumor differentiation, and tumor location. Statistical analyses including chi-square test, Mann-Whitney U test, univariate analyses and Kaplan-Meier method and log-rank test were performed using the data after PSM to investigate the benefits of LS compared with OP.

RESULTS:

After PSM analysis, 460 patients remained in the study. The LS group had lower intraoperative blood loss (34 ± 70 vs 237 ± 391, mL; P < 0.001), lower frequency of postoperative small bowel obstruction (SBO) (17/213 vs 30/230; P = 0.045), lower rate of nasogastric tube insertion (7/223 vs 17/213; P = 0.036), and shorter postoperative hospital stay (13 ± 10 vs 25 ± 47, day; P < 0.001) than the OP group. Univariate analyses showed that LS significantly reduced the risk of postoperative SBO (odds ratio [OR] 0.532; 95% confidence interval [CI] 0.285-0.995; P = 0.048) and nasogastric tube insertion (OR 0.393; 95% CI 0.160-0.967; P = 0.042) compared with OP. There were no significant differences in OS and RFS between the groups.

CONCLUSIONS:

LS reduced intraoperative blood loss, frequency of postoperative SBO, rate of nasogastric tube insertion, and postoperative hospital stay compared with OP.

• Authors: Kotaro Suda, Takayuki Shimizu, Mitsuru Ishizuka, Shotaro Miyashita, Maiko Niki, Norisuke Shibuya, Hiroyuki Hachiya, Takatsugu Matsumoto, Takayuki Shiraki, Yuhki Sakuraoka, Shozo Mori, Yukihiro Iso, Kazutoshi Takagi, Taku Aoki, Keiichi Kubota
• Journal: Surgical endoscopy (Surg Endosc) Vol. 36 Issue 12 Pg. 8790-8796 (12 2022) ISSN: 1432-2218 [Electronic] Germany
• PMID: 35556165 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Topics

• Humans
• Propensity Score
• Length of Stay
• Retrospective Studies
• Blood Loss, Surgical
• Laparoscopy (methods)
• Intestinal Obstruction (epidemiology, etiology, prevention & control)
• Postoperative Complications (epidemiology, etiology, prevention & control)
• Colorectal Neoplasms (surgery, complications)
• Treatment Outcome