Pei KY, et al. – Ascites increases perioperative complications and risk of death, but is not an absolute contraindication for colectomy in patients with colon cancer. This work was performed to assess whether postoperative risks can be minimized using a laparoscopic versus open approach. Observations revealed that laparoscopic colectomy resulted in reduction in postoperative complications and hospital length of stay in these patients. Authors recommended considering laparoscopic approach for patients in this high–risk population.

Methods

• Researchers retrospectively analyzed 2152 patients with ascites who underwent laparoscopic or open partial colectomy with diagnosis of colon cancer from 2005 to 2013 using the American College of Surgeons National Surgical Quality Improvement Program database.
• Using two-sample tests of proportions and two-sample T tests, they analyzed postoperative outcomes.
• Using multivariable logistic or linear regression, calculation of adjusted odds ratios (OR) or β coefficients for postoperative complications, hospital length of stay, and 30-day mortality was performed.
• In this study, Pvalues <0.05 two-tailed were considered statistically significant.

Results

• Laparoscopic colectomy (LC) was performed on 205 patients (9.53%) with ascites.
• No significant difference was observed regarding operative time between laparoscopic versus open surgery (145 vs. 146 min, P = 0.69).
• LC seemed associated with decreased likelihood of overall complications (adjusted OR 0.7 95% CI 0.4–1.0, P = 0.046) and shorter hospital length of stay (9 days vs. 15 days, adjusted β = -4.2, 95% CI -7.7 to -0.7, P = 0.018).
• Observations suggested no difference in 30-day mortality (adjusted OR 0.82, 95% CI 0.50–1.35, P = 0.429).