SP3.10 - Utilisation and Outcomes of Emergency Laparoscopic Resection for Colon Cancer: A Population-based Study in England

Abstract

Abstract Aims To evaluate the current use and outcomes of urgent or emergency laparoscopic resection of colon cancer in the National Health Service in England. Methods 11,182 patients from the National Bowel Cancer Audit diagnosed with colon cancer from April 2017 to March 2022 in England, who underwent urgent or emergency resection, were included. Multivariable logistic and linear regression was used to quantify factors associated with use of laparoscopic surgery and compare risk-adjusted postoperative outcomes between laparoscopic and open surgery. Results The use of emergency laparoscopic resection increased from 33.0% in 2017 to 47.5% in 2022, with a temporary stabilisation during the first wave of the COVID-19 pandemic (38.9% 2020/21). In risk-adjusted analyses of 9,579 patients, patients with poorer physical status [ASA 4/5 vs 1, aOR 0.35 (95% confidence interval 0.27-0.44) P < 0.001], more advanced T-stage [T4 vs T1-T2, aOR 0.26 (0.21-0.32) P < 0.001] and M-stage [M1 vs M0, aOR 0.87 (0.76-0.99) P < 0.036] were less likely to undergo laparoscopic surgery. No association was found with age, socioeconomic deprivation, or nodal stage. Patients undergoing laparoscopic resection had a shorter length of stay [adjusted mean difference -2.55 days (-3.23, -1.87), P < 0.001], lower 90-day mortality [aOR 0.75 (0.63-0.89), P = 0.001], and lower 30-day unplanned reoperation [aOR 0.82 (0.70-0.96), P = 0.014] than patients undergoing open resection. Conclusion There has been an increased utilisation of laparoscopic surgery in the emergency setting, and it is associated with reduced hospital stay, postoperative mortality and unplanned reoperation.