Outcomes of laparoscopic and open surgery for colorectal cancer in the emergency setting

To evaluate the short-term and oncological outcomes of laparoscopy compared to open procedures for colorectal cancer in the emergency setting.

Forty-nine consecutive patients undergoing emergency open (n=38) or laparoscopic (n=11) major resection were analyzed.

There were no significant differences in age, gender, American Society of Anesthesiologists (ASA) score, body mass index (BMI), history of previous abdominal surgery and tumor location between the open and laparoscopy groups. Pathological T4 tumors were more commonly observed in the open-surgery group than the laparoscopy group (47% vs. 9%; p=0.022). Obstruction (45% vs. 27%) and perforation (42% vs. 27%) were also more common in the open-surgery group. Bleeding or anemia was more common in the laparoscopy group (8% vs. 45%; p=0.028). There were no open conversions in the laparoscopy group. Regarding the type of surgery, Hartmann's operation was more common in the open-surgery group (32%) and right hemicolectomy was more common in the laparoscopy group (36%; p=0.058). There was no difference in the 30-day complication rate of open surgery (34%) and laparoscopy (36%) (p=0.895). Mean time to tolerable diet (8 days vs. 6 days, p=0.035) and mean length of hospital stay (17 days vs. 13 days, p=0.041) were shorter in the laparoscopy group. Overall recurrence and cancer-specific death did not differ between the two groups.

In selected colorectal cancer patients, emergency laparoscopy confers benefits in terms of short-term and oncological outcomes. Therefore, experienced laparoscopic surgeons may more actively consider the use of laparoscopy in the emergency setting.