Quantitative comparison of the difficulty of performing laparoscopic colectomy at different tumor locations.
BACKGROUND
Laparoscopic approaches of colectomy for colonic cancer are increasingly surpassing the mainstream open colectomy approach. Impact of disease variables, such as tumor location, has not been adequately measured in quality improvement initiatives. Quantitative analysis concerning the difficulty performing these procedures and differences in postoperative care depending on tumor site will contribute to the development of training programs and to the assessment of quality of care strategies.


METHODS
A total of 3,765 cases received laparoscopic colectomy (LC). Patient demographics, weighted comorbidities, procedure-related complications, stapling devices, operating room (OR) time, postoperative length of hospital stay (LOS), or total charges (TC) were categorized and compared based on tumor location: cecum to ascending, transverse, descending, and sigmoid colon. Multivariate analyses determined the impact of tumor location on postoperative LOS, TC, OR time, and complications.


RESULTS
Sigmoid colon was the most frequent tumor placement (40.5%). Significant differences in age, gender, frequency of blood transfusion, use of stapling devices, OR time, and postoperative LOS were observed among tumor locations. Transverse colon was the most significant determinant of postoperative LOS and TC, whereas descending colon tumors correlated with increased OR time. Greater OR time was associated with more postoperative resource use and complications.


CONCLUSIONS
Tumor location, complications, and OR time affected postoperative resource use, whereas greater OR time signified an increased occurrence of complications. Developers of LC training programs or healthcare policy makers should consider the quantitative impact of tumor locations when attempting to improve effective skill training or to survey the quality of LC performance.
Kuwabara
Kazuaki
K
Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan. kazu228@basil.ocn.ne.jp
Matsuda
Shinya
S
Fushimi
Kiyohide
K
Ishikawa
Koichi B
KB
Horiguchi
Hiromasa
H
Fujimori
Kenji
K
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D017722:Hospital Charges; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D017792:Surgical Stapling / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome