S. T. Lumpkin1, P. D. Strassle1,2, L. N. Purcell1, N. Lopez3, K. B. Stitzenberg1 1University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Epidemiology,Chapel Hill, NC, USA 3University Of California – San Diego,Surgery,San Diego, CA, USA
Introduction: Minimally invasive synchronous resection of primary colon cancer and metastatic liver lesions has been proven safe and effective. We hypothesized that the proportion of synchronous resections performed laparoscopically has increased.
Methods: Using the National Inpatient Sample (NIS) from 2009-2015, we identified all adult patients with colon cancer undergoing colon resection alone and those undergoing a synchronous colon and liver resection based on ICD-9 codes. We compared the pace of laparoscopic uptake in the synchronous resection cohort to our control group, colon resections. All surgeries were classified as either laparoscopic or open. The yearly incidence of laparoscopic procedures was calculated using Poisson regression. Chi-square and Wilcoxon tests were used to compare patient and hospital characteristics.
Results: Overall, 86,520 patients with colon cancer were identified, 55,766 underwent colon resections alone and 754 underwent synchronous resections. Wedge resections composed 50% of liver procedures. Laparoscopic procedures constituted 27,158 (49%) of the colon resections and 161 (21%) of synchronous resections, p<0.0001. Laparoscopic procedures have increased significantly in both colon resection (42% to 54%) and synchronous resections (11% to 32%) between 2009 and 2015, p<0.0001 and p=0.006, respectively, (Figure), although there was no significant difference in the pace of uptake of laparoscopy between groups (p=0.09). Robotics composed 3% of all operations, and robot use was similar between colon resection and synchronous resections (p=0.13). Among synchronous resections, patients undergoing laparoscopic and open procedures were similar in regards to age (p=0.26), sex (p=0.69), race/ethnicity (p=0.28), insurance status (p=0.52), median household income (p=0.30), Charlson Comorbidity Index (p=0.19), and hospital size (p=0.95). However, significant differences were seen across colectomy procedure (p=0.004), liver procedure (p=0.0001), and hospital region (p=0.04). Specifically among synchronous resections, a laparoscopic approach was more likely performed in patients undergoing a left hemicolectomy (29% vs. 17%), liver ablation (32% vs. 18%), and among patients having surgery in the West (30% vs 19%). Laparoscopic approach was significantly less common among patients undergoing right hemicolectomy (19% vs. 25%, p=0.049). No difference was seen across teaching hospital status (21% vs. 24%, p=0.36).
Conclusions: Laparoscopic synchronous resection of colon and liver disease for colon cancer is becoming increasingly popular nationwide. The type of colon resection and liver procedure performed may guide a surgeon’s operative approach. There are also regional differences in practice patterns.
