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Comparison of patient-reported outcomes in laparoscopic and open right hemicolectomy: a retrospective cohort study

Vela N, Bubis LD, Davis LE, Mahar AL, Kennedy E, Coburn NG. Dis Colon Rectum. 2019; Sep 20 [Epub ahead of print]. DOI: https://doi.org/10.1097/DCR.0000000000001485


Background — Open and laparoscopic resections for colon cancer have equivalent perioperative morbidity and mortality. However, there are little data concerning patient-reported outcomes in the early postdischarge period.

Objective — We examined patient-reported outcomes in the early postdischarge period for open and laparoscopic right hemicolectomy for colon cancer.

Design — This was a retrospective cohort study.

Settings — The study was conducted using linked administrative healthcare databases in the province of Ontario, Canada.

Patients — Patients undergoing laparoscopic or open right hemicolectomy for colon cancer between January 2010 and December 2014 were identified using the Ontario Cancer Registry and physician billing data.

Main Outcome Measures — The primary outcome was the presence of moderate-to-severe symptom scores on the Edmonton Symptom Assessment System (≥4 of 10) within 6 weeks of hospital discharge after right hemicolectomy.

Results — A total of 1022 patients completed ≥1 Edmonton Symptom Assessment System survey within 6 weeks of surgery and were included in the study. Patients undergoing laparoscopic resection were more likely to have an urban residence, to have undergone planned resections, and to have had proportionally more stage 1 disease compared with patients undergoing open resection. On multivariable analyses, adjusting for patient demographics, cancer stage, and planned versus unplanned admission status, there were no differences in the adjusted odds of moderate-to-severe symptom scores between the laparoscopic and open approaches.

Limitations — Edmonton Symptom Assessment System scores are not collected for inpatients and thus only represent outpatient postoperative visits. Scores were reported by 19% of all resections in the population, with a bias to patients treated at cancer centers, and therefore they are not fully representative of the general population of right hemicolectomy. The Edmonton Symptom Assessment System is not a disease-specific tool and may not measure all relevant outcomes for patients undergoing right hemicolectomy.

Conclusions — Receipt of the open or laparoscopic surgical technique was not associated with increased risk of elevated symptom burden in the early postdischarge period.

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