Efficacy of laparoscopic versus open surgery in malnourished patients with colorectal cancer

Patients with colorectal cancer often present with malnutrition before surgery, which can negatively impact surgical outcomes. While laparoscopic surgery has demonstrated better short-term outcomes than open surgery, the potential differences in the efficacies of these two surgical approaches in malnourished patients with colorectal cancer remain unclear.

This study enrolled colorectal cancer patients with Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition who underwent elective radical resection between 2015 and 2022. Patients were divided into two groups based on the surgery type. Propensity score matching (PSM) was used to balance clinicopathological characteristics between the two groups. Postoperative outcomes and survival were compared between the groups, and multivariate analysis was performed to identify independent risk factors for complications, overall survival (OS), and disease-free survival (DFS).

After PSM of 424 enrolled patients with malnutrition, the laparoscopic and open surgery groups each included 173 patients. Compared with the open radical resection group, the laparoscopic radical resection group exhibited lower incidences of total (p = 0.011) and surgical (p = 0.034) complications as well as a reduced postoperative hospital stay (p < 0.001). Laparoscopic resection was also associated with superior OS (p = 0.0232) and DFS (p = 0.0401). Finally, laparoscopic surgery was identified as an independent protective factor against total complications, surgical complications, and OS.

Colorectal cancer patients with malnutrition who underwent laparoscopic surgery showed a lower incidence of total postoperative and surgical complications, reduced postoperative hospital stay, and improved OS and DFS. Therefore, laparoscopic surgery was associated with favorable postoperative outcomes in this specific patient population.