Outcomes of Colectomy for Nonmalignant Polyps and Colon Cancer: A Propensity Score-Matched Analysis

In the United States, while most nonmalignant polyps are effectively treated through endoscopic removal, colectomy remains a treatment option for selected cases of nonmalignant polyps (NMPs) and colon cancer. This study aimed to compare postoperative outcomes for colectomies in these two conditions, hypothesizing similar complication rates.

We conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2021, including patients who underwent elective colectomies for colon cancer or NMPs. Using a 2:1 propensity score matching for demographics, American Society of Anesthesiologists classification, surgical methods, and comorbidities, we evaluated outcomes such as 30-d mortality, complications, anastomotic leakage, and hospital stay duration.

A total of 47,960 patients, including 30,549 colon cancer patients and 17,411 NMP patients, were included after propensity score matching analysis. We concluded that there was no significant difference in mortality and reoperation rates which were 0.6% and 3.3% in patients undergoing colectomy with colon cancer, compared to 0.5% and 3.1% in those with NMP, respectively [P = 0.64, P = 0.21,]. In addition, the anastomotic leak rates were remarkably similar in both the colon cancer (2.4%) and NMP (2.2%) groups. [P = 0.13]. Most of the 30-d postoperative surgical complications, such as sepsis, septic shock, wound disruption, and urinary tract infection exhibited similar incidence rates, however, some of them, such as readmission, pulmonary embolism, and length of stay, varied between the groups.

Our findings underscore the similar postoperative outcomes between colon cancer and NMP groups, advocating for consideration of advanced endoscopic techniques for NMPs to potentially enhance patient care and outcomes.