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Updated: May 16, 2026
Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
A nationwide analysis of laparoscopy in high-risk colorectal surgery patients
Celeste Y Kang1, Wissam J Halabi, Obaid O Chaudhry
1Department of Colorectal Surgery, University of California, Irvine School of Medicine, 333 City Blvd. West Suite 850, Orange, CA 92868, USA.
Background:
Due to safety concerns, the use of laparoscopy in high-risk colorectal surgery patients has been limited. Small reports have demonstrated the benefit of laparoscopy in this population; however, large comparative studies are lacking.
Study Design:
A retrospective review of the Nationwide Inpatient Sample 2009 was conducted. Patients undergoing elective colorectal resections for benign and malignant pathology were included in the high-risk group if they had at least two of the following criteria: age > 70, obesity, smoking, anemia, congestive heart failure, valvular disease, diabetes mellitus, chronic pulmonary, kidney and liver disease. Using multivariate logistic regression, the outcomes of laparoscopic surgery were compared to open and converted surgery.
Results:
Of 145,600 colorectal surgery cases, 32.79% were high-risk. High-risk patients had higher mortality, hospital charges, and longer hospital stay compared to low-risk patients. The use of laparoscopy was lower in the high-risk group with higher conversion rates. In high-risk patients, compared to open surgery, laparoscopy was associated with lower mortality (OR = 0.60), shorter hospital stay, lower charges, decreased respiratory failure (OR = 0.53), urinary tract infection (OR = 0.64), anastomotic leak (OR = 0.69) and wound complications (OR = 0.46). Conversion to open surgery was not associated with higher mortality.
Conclusions:
Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.
