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J Rua, P Kondylis
University of Central Florida/HCA: Greater Orlando

Major anastomotic septic complications (SC) remain an important source of morbidity and mortality among patients undergoing oncologic colon resection. In this retrospective study, we compare differences in SC between laparoscopic and open colon resections.

Patient data in this retrospective study are from the prospectively accrued HCA Healthcare enterprise-wide database. This included colon cancer patients aged 18-90 who underwent curative intent laparoscopic or open colonic resection from 2014 to 2018. Using a logistics regression model, SC between laparoscopic and open procedures were analyzed statistically against age, gender, race, BMI, ethnicity, steroid administration, anticoagulant use and renal failure. SC was defined as anastomotic leak, abscess formation or anastomotic fistula. Exclusion criteria included superficial wound infections, proctectomy, and palliative resection.

7,288 patients met criteria for study. Fifty-three percent were male. The mean age was 67.4. Of those, there were 3,496 laparoscopic (47.97%), 3,401 open (46.67%) and 391 combined/converted cases (5.36%). There was a total of 281 patients with SC (3.86%); 108 (3.09%), 150 (4.41%) and 23 (5.88%) from the laparoscopic, open and combination/converted groups respectively. Those who underwent laparoscopic surgery were less likely to develop SC (p=0.0021, odds ratio (OR)=0.7, 95% confidence interval (CI)=0.543-0.903). Female patients were less likely to develop SC (p<0.0001, OR=0.524, 95% CI=0.405-0.679). Hispanic patients were more likely to develop SC (p=0.0109, OR=1.542, 95% CI=1.105-2.152). Those without renal failure were less likely to develop SC (p=0.0332, OR=0.674, 95% CI=0.469-0.969). Those without steroid therapy were less likely to develop SC (p<0.0001, OR=0.443, 95% CI=0.314-0.626). Patient age, race, BMI and anticoagulant use were not found to be statistically significant.

Previous studies showed that laparoscopic and open colon resections had similar outcomes with long term morbidity, survival and cancer recurrence. Our study demonstrates that laparoscopic surgery was associated with fewer major anastomotic septic complications. Female and non-Hispanic patients had lesser risk for SC. Steroid use and renal failure patients had increased risk for SC.

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