Risk Factors for Compromised Surgical Resection: A Nationwide Propensity Score-Matched Study on Laparoscopic and Open Resection for Colonic Cancer
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Standard
Risk Factors for Compromised Surgical Resection : A Nationwide Propensity Score-Matched Study on Laparoscopic and Open Resection for Colonic Cancer. / Vogelsang, Rasmus P; Klein, Mads F; Gögenur, Ismail.
I: Diseases of the Colon and Rectum, Bind 62, Nr. 4, 04.2019, s. 438-446.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Harvard
APA
Vancouver
Author
Bibtex
}
RIS
TY - JOUR
T1 - Risk Factors for Compromised Surgical Resection
T2 - A Nationwide Propensity Score-Matched Study on Laparoscopic and Open Resection for Colonic Cancer
AU - Vogelsang, Rasmus P
AU - Klein, Mads F
AU - Gögenur, Ismail
PY - 2019/4
Y1 - 2019/4
N2 - BACKGROUND: High-quality surgical resection of colonic cancer, including dissection along the embryologic mesocolic plane, translates into improved long-term oncological outcomes.OBJECTIVE: This study aimed to identify risk factors for compromised specimen quality and to evaluate the specimen quality of patients undergoing laparoscopic and open resection for colonic cancer.DESIGN: This is a retrospective observational study.SETTINGS: This database study is based on the prospective national Danish Colorectal Cancer Database including patients undergoing intended curative elective colonic cancer surgery from January 1, 2010 through December 2013.PATIENTS: A total of 5143 patients (1602 open resections; 3541 laparoscopic resections) with colonic cancer were included.MAIN OUTCOME MEASURES: Risk factors for poor resection quality were identified through uni- and multivariate logistic regression analysis. The surgical approach was assessed by propensity score-matched regression analysis. Poor resection quality was defined as resections in the muscularis plane accompanied by R0 resection, or resections in any resection plane accompanied by R1 resection.RESULTS: Overall, 4415 (85.8%) of the resections were considered good and 728 (14.2%) were considered poor. After multivariate analysis, neoadjuvant oncological treatment, advanced tumor stage (T3-4), advancing N stage (N1-2), open tumor perforation, and open surgery significantly increased the risk of poor resection quality. In a propensity score-matched sample (n = 1508 matched pairs), matched for age, sex, ASA score, BMI, neoadjuvant treatment, tumor stage, and tumor location, open resection was still associated with a higher risk of poor resection quality compared with laparoscopic resection (OR, 1.4; 95% CI, 1.1-1.8; p = 0.002).LIMITATIONS: Retrospective design was a limitation of this study.CONCLUSIONS: In this nationwide propensity score-matched database study, laparoscopic resection was associated with a higher probability of good resection quality compared with open resection for colonic cancer. Risk factors for compromised specimen quality were neoadjuvant oncological treatment, locally advanced tumor stage (T3-4), advanced N stage (N1-2), open tumor perforation, and open surgery. See Video Abstract at http://links.lww.com/DCR/A830.
AB - BACKGROUND: High-quality surgical resection of colonic cancer, including dissection along the embryologic mesocolic plane, translates into improved long-term oncological outcomes.OBJECTIVE: This study aimed to identify risk factors for compromised specimen quality and to evaluate the specimen quality of patients undergoing laparoscopic and open resection for colonic cancer.DESIGN: This is a retrospective observational study.SETTINGS: This database study is based on the prospective national Danish Colorectal Cancer Database including patients undergoing intended curative elective colonic cancer surgery from January 1, 2010 through December 2013.PATIENTS: A total of 5143 patients (1602 open resections; 3541 laparoscopic resections) with colonic cancer were included.MAIN OUTCOME MEASURES: Risk factors for poor resection quality were identified through uni- and multivariate logistic regression analysis. The surgical approach was assessed by propensity score-matched regression analysis. Poor resection quality was defined as resections in the muscularis plane accompanied by R0 resection, or resections in any resection plane accompanied by R1 resection.RESULTS: Overall, 4415 (85.8%) of the resections were considered good and 728 (14.2%) were considered poor. After multivariate analysis, neoadjuvant oncological treatment, advanced tumor stage (T3-4), advancing N stage (N1-2), open tumor perforation, and open surgery significantly increased the risk of poor resection quality. In a propensity score-matched sample (n = 1508 matched pairs), matched for age, sex, ASA score, BMI, neoadjuvant treatment, tumor stage, and tumor location, open resection was still associated with a higher risk of poor resection quality compared with laparoscopic resection (OR, 1.4; 95% CI, 1.1-1.8; p = 0.002).LIMITATIONS: Retrospective design was a limitation of this study.CONCLUSIONS: In this nationwide propensity score-matched database study, laparoscopic resection was associated with a higher probability of good resection quality compared with open resection for colonic cancer. Risk factors for compromised specimen quality were neoadjuvant oncological treatment, locally advanced tumor stage (T3-4), advanced N stage (N1-2), open tumor perforation, and open surgery. See Video Abstract at http://links.lww.com/DCR/A830.
KW - Aged
KW - Colectomy/adverse effects
KW - Colonic Neoplasms/pathology
KW - Databases, Factual/statistics & numerical data
KW - Denmark/epidemiology
KW - Female
KW - Humans
KW - Laparoscopy/adverse effects
KW - Male
KW - Neoadjuvant Therapy/methods
KW - Neoplasm Staging
KW - Outcome Assessment, Health Care/statistics & numerical data
KW - Postoperative Complications/classification
KW - Propensity Score
KW - Quality Improvement
KW - Retrospective Studies
KW - Risk Factors
U2 - 10.1097/DCR.0000000000001304
DO - 10.1097/DCR.0000000000001304
M3 - Journal article
C2 - 30844971
VL - 62
SP - 438
EP - 446
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 4
ER -
ID: 233726098