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Published in: Surgical Endoscopy 9/2019

01-09-2019

Short-term outcomes after elective colon cancer surgery: an observational study from the Norwegian registry for gastrointestinal and HPB surgery, NoRGast

Authors: L. S. Nymo, S. Norderval, M. T. Eriksen, H. H. Wasmuth, H. Kørner, B. A. Bjørnbeth, T. Moger, A. Viste, K. Lassen

Published in: Surgical Endoscopy | Issue 9/2019

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Abstract

Background

To describe the real burden of major complications after elective surgery for colon cancer in Norway, and to assess which predictors that are significantly associated with the short-term outcome.

Methods

An observational, multi-centre analysis of prospectively registered colon resections registered into the Norwegian Registry for Gastrointestinal Surgery, NoRGast, between January 2014 and December 2016. A propensity score-adjusted subgroup analysis for surgical access groups was attempted, with laparoscopic resections grouped as intention-to-treat.

Results

Out of 1812 resections, 14.0% of patients experienced a major complication within 30 days following surgery. The over-all reoperation rate was 8.7%, and rate of reoperation for anastomotic leak was 3.8%. Twenty patients (1.1%) died within 30 days after surgery. Higher age was not a significant predictor of major complications, including 30-day mortality. After correction for all co-variables, open access surgery was associated with higher rates of major complications (OR 1.67 (CI 1.22–2.29), p = 0.002), higher 30-day mortality (OR 4.39 (CI 1.19–16.13) p = 0.026) and longer length-of-stay (HR 0.58 (CI 0.52–0.65) p < 0.001).

Conclusions

Our results indicate a low complication burden and high rate of uneventful patient journeys after elective surgery for colon cancer in Norway. Age was not associated with higher morbidity or mortality rates. Open access surgery was associated with an inferior short-term outcome.
Literature
1.
go back to reference Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386CrossRefPubMed Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5):E359–E386CrossRefPubMed
4.
go back to reference Aahlin EK, Olsen F, Uleberg B, Jacobsen BK, Lassen K (2016) Major postoperative complications are associated with impaired long-term survival after gastro-esophageal and pancreatic cancer surgery: a complete national cohort study. BMC Surg 16(1):32CrossRefPubMedPubMedCentral Aahlin EK, Olsen F, Uleberg B, Jacobsen BK, Lassen K (2016) Major postoperative complications are associated with impaired long-term survival after gastro-esophageal and pancreatic cancer surgery: a complete national cohort study. BMC Surg 16(1):32CrossRefPubMedPubMedCentral
5.
go back to reference Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. In: Transactions of the Meeting of the American Surgical Association, vol 123, pp 32–48 Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ (2005) Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. In: Transactions of the Meeting of the American Surgical Association, vol 123, pp 32–48
6.
go back to reference Pucher PH, Aggarwal R, Qurashi M, Darzi A (2014) Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg 101(12):1499–1508CrossRefPubMed Pucher PH, Aggarwal R, Qurashi M, Darzi A (2014) Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg 101(12):1499–1508CrossRefPubMed
7.
go back to reference Lassen K, Nymo LS, Norderval S (2017) The new national registry for gastrointestinal surgery in Norway: NoRGast. Scand J Surg 107(3):7 Lassen K, Nymo LS, Norderval S (2017) The new national registry for gastrointestinal surgery in Norway: NoRGast. Scand J Surg 107(3):7
10.
go back to reference Haga Y, Ikejiri K, Wada Y, Takahashi T, Ikenaga M, Akiyama N et al (2011) A multicenter prospective study of surgical audit systems. Ann Surg 253(1):194–201CrossRefPubMed Haga Y, Ikejiri K, Wada Y, Takahashi T, Ikenaga M, Akiyama N et al (2011) A multicenter prospective study of surgical audit systems. Ann Surg 253(1):194–201CrossRefPubMed
11.
go back to reference Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250(2):177–186CrossRefPubMed Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250(2):177–186CrossRefPubMed
12.
go back to reference Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424CrossRef Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424CrossRef
13.
go back to reference von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349CrossRef von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349CrossRef
14.
go back to reference Swedish colorectal cancer registry: National report, 2015 (2016) ISBN 91-89048-63-6. Swedish colorectal cancer registry: National report, 2015 (2016) ISBN 91-89048-63-6.
16.
go back to reference Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis 32(4):549–556CrossRefPubMedPubMedCentral Gessler B, Eriksson O, Angenete E (2017) Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis 32(4):549–556CrossRefPubMedPubMedCentral
17.
go back to reference Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101(4):424–432CrossRefPubMed Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101(4):424–432CrossRefPubMed
18.
go back to reference Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen LL (2016) Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol 16(1):55CrossRefPubMedPubMedCentral Sarin A, Litonius ES, Naidu R, Yost CS, Varma MG, Chen LL (2016) Successful implementation of an Enhanced Recovery After Surgery program shortens length of stay and improves postoperative pain, and bowel and bladder function after colorectal surgery. BMC Anesthesiol 16(1):55CrossRefPubMedPubMedCentral
19.
go back to reference Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ (2011) Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum 54(1):21–28CrossRefPubMed Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ (2011) Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum 54(1):21–28CrossRefPubMed
20.
go back to reference Shum NF, Choi HK, Mak JC, Foo DC, Li WC, Law WL (2016) Randomized clinical trial of chewing gum after laparoscopic colorectal resection. Br J Surg 103(11):1447–1452CrossRefPubMed Shum NF, Choi HK, Mak JC, Foo DC, Li WC, Law WL (2016) Randomized clinical trial of chewing gum after laparoscopic colorectal resection. Br J Surg 103(11):1447–1452CrossRefPubMed
21.
go back to reference Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching. JAMA Surg 149(2):177–184CrossRefPubMedPubMedCentral Juo YY, Hyder O, Haider AH, Camp M, Lidor A, Ahuja N (2014) Is minimally invasive colon resection better than traditional approaches?: First comprehensive national examination with propensity score matching. JAMA Surg 149(2):177–184CrossRefPubMedPubMedCentral
22.
go back to reference Woodfield JC, Jamil W, Sagar PM (2016) Incidence and significance of postoperative complications occurring between discharge and 30 days: a prospective cohort study. J Surg Res 206(1):77–82CrossRefPubMed Woodfield JC, Jamil W, Sagar PM (2016) Incidence and significance of postoperative complications occurring between discharge and 30 days: a prospective cohort study. J Surg Res 206(1):77–82CrossRefPubMed
23.
go back to reference Gonzalez-Ayora S, Pastor C, Guadalajara H, Ramirez JM, Royo P, Redondo E et al (2016) Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Colorectal Dis 31(9):1625–1631CrossRefPubMedPubMedCentral Gonzalez-Ayora S, Pastor C, Guadalajara H, Ramirez JM, Royo P, Redondo E et al (2016) Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Colorectal Dis 31(9):1625–1631CrossRefPubMedPubMedCentral
24.
go back to reference Allaix ME, Furnee EJ, Mistrangelo M, Arezzo A, Morino M (2016) Conversion of laparoscopic colorectal resection for cancer: what is the impact on short-term outcomes and survival? World J Gastroenterol 22(37):8304–8313CrossRefPubMedPubMedCentral Allaix ME, Furnee EJ, Mistrangelo M, Arezzo A, Morino M (2016) Conversion of laparoscopic colorectal resection for cancer: what is the impact on short-term outcomes and survival? World J Gastroenterol 22(37):8304–8313CrossRefPubMedPubMedCentral
25.
go back to reference de Neree Tot Babberich MPM, van Groningen JT, Dekker E, Wiggers T, Wouters M, Bemelman WA et al (2018) Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level? Surg Endosc 32(7):3234–3246CrossRefPubMedPubMedCentral de Neree Tot Babberich MPM, van Groningen JT, Dekker E, Wiggers T, Wouters M, Bemelman WA et al (2018) Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level? Surg Endosc 32(7):3234–3246CrossRefPubMedPubMedCentral
26.
go back to reference Jafari MD, Jafari F, Halabi WJ, Nguyen VQ, Pigazzi A, Carmichael JC et al (2014) Colorectal cancer resections in the aging US population: a trend toward decreasing rates and improved outcomes. JAMA Surg 149(6):557–564CrossRefPubMed Jafari MD, Jafari F, Halabi WJ, Nguyen VQ, Pigazzi A, Carmichael JC et al (2014) Colorectal cancer resections in the aging US population: a trend toward decreasing rates and improved outcomes. JAMA Surg 149(6):557–564CrossRefPubMed
27.
go back to reference Yang L, Ma Q, Yu YY, Wang C, Meng WJ, Adell G et al (2014) Efficacy of surgery and adjuvant therapy in older patients with colorectal cancer: a STROBE-compliant article. Medicine 93(28):e266CrossRefPubMedPubMedCentral Yang L, Ma Q, Yu YY, Wang C, Meng WJ, Adell G et al (2014) Efficacy of surgery and adjuvant therapy in older patients with colorectal cancer: a STROBE-compliant article. Medicine 93(28):e266CrossRefPubMedPubMedCentral
28.
go back to reference Fujii SIA, Ota M, Yamagishi S et al (2014) Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc 28:466–476CrossRefPubMed Fujii SIA, Ota M, Yamagishi S et al (2014) Short-term results of a randomized study between laparoscopic and open surgery in elderly colorectal cancer patients. Surg Endosc 28:466–476CrossRefPubMed
29.
go back to reference Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev 34(6):498–504CrossRefPubMed Kuhry E, Schwenk W, Gaupset R, Romild U, Bonjer J (2008) Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat Rev 34(6):498–504CrossRefPubMed
30.
go back to reference Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMed Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726CrossRefPubMed
31.
go back to reference Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F et al (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260(1):23–30CrossRefPubMed Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F et al (2014) Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg 260(1):23–30CrossRefPubMed
32.
go back to reference Allaix ME, Giraudo G, Mistrangelo M, Arezzo A, Morino M (2015) Laparoscopic versus open resection for colon cancer: 10-year outcomes of a prospective clinical trial. Surg Endosc 29(4):916–924CrossRefPubMed Allaix ME, Giraudo G, Mistrangelo M, Arezzo A, Morino M (2015) Laparoscopic versus open resection for colon cancer: 10-year outcomes of a prospective clinical trial. Surg Endosc 29(4):916–924CrossRefPubMed
33.
go back to reference Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645CrossRefPubMed Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–1645CrossRefPubMed
34.
go back to reference Martel G, Crawford A, Barkun JS, Boushey RP, Ramsay CR, Fergusson DA (2012) Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials. PLoS ONE 7(4):e35292CrossRefPubMedPubMedCentral Martel G, Crawford A, Barkun JS, Boushey RP, Ramsay CR, Fergusson DA (2012) Expert opinion on laparoscopic surgery for colorectal cancer parallels evidence from a cumulative meta-analysis of randomized controlled trials. PLoS ONE 7(4):e35292CrossRefPubMedPubMedCentral
35.
go back to reference Babaei M, Balavarca Y, Jansen L, Gondos A, Lemmens V, Sjovall A et al (2016) Minimally invasive colorectal cancer surgery in Europe: implementation and outcomes. Medicine 95(22):e3812CrossRefPubMedPubMedCentral Babaei M, Balavarca Y, Jansen L, Gondos A, Lemmens V, Sjovall A et al (2016) Minimally invasive colorectal cancer surgery in Europe: implementation and outcomes. Medicine 95(22):e3812CrossRefPubMedPubMedCentral
36.
go back to reference Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer 3:49–57CrossRefPubMedPubMedCentral Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer 3:49–57CrossRefPubMedPubMedCentral
38.
go back to reference Stormark K, Søreide K, Søreide JA, Kvaløy JT, Pfeffer F, Eriksen MT et al (2016) Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort. Surg Endosc 30(11):4853–4864CrossRefPubMed Stormark K, Søreide K, Søreide JA, Kvaløy JT, Pfeffer F, Eriksen MT et al (2016) Nationwide implementation of laparoscopic surgery for colon cancer: short-term outcomes and long-term survival in a population-based cohort. Surg Endosc 30(11):4853–4864CrossRefPubMed
Metadata
Title
Short-term outcomes after elective colon cancer surgery: an observational study from the Norwegian registry for gastrointestinal and HPB surgery, NoRGast
Authors
L. S. Nymo
S. Norderval
M. T. Eriksen
H. H. Wasmuth
H. Kørner
B. A. Bjørnbeth
T. Moger
A. Viste
K. Lassen
Publication date
01-09-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6575-4

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