title: Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study.
abstract: BACKGROUND
  Case series suggest the feasibility and safety of emergency resection of colon cancer by laparoscopy. The present study compares short- and long-term outcomes of laparoscopic and open resection for colon cancers treated as emergencies.
  
  
  METHODS
  The study was a propensity score-matched design based on a prospective database. From October 2006 to December 2011, emergency laparoscopic colon cancer resections were 1:2 propensity score-matched to open cases. Covariates for match-estimation were age, gender, American Society of Anesthesiologists grade, procedure type, tumor site, and reason for emergency surgery. Short-term outcomes included oncological quality surrogates (lymph node harvest and R stage), need for a stoma, length of hospital stay, and postoperative complications. For long-term outcomes, overall and recurrence-free survival rates were analyzed with Kaplan-Meier curves.
  
  
  RESULTS
  During the study period, a total of 217 colon cancers were resected (181 open and 36 laparoscopic) as emergencies. The laparoscopic cases were matched to 72 open cases. Median follow-up was 3.6 [95 % confidence interval (CI) 2.3-4.3] years. The overall 3-year survival rate was 51 % (95 % CI 35-76) in the laparoscopic group versus 43 % (95 % CI 32-58) in the open group (p = 0.24). The 3-year recurrence-free survival rate in the laparoscopic group was 35 % (95 % CI 20-60) versus 37 % (95 % CI 27-50) in the open group (p = 0.53). Median lymph node harvest (17 vs. 13 nodes; p = 0.041) and median length of hospital stay (7.5 vs. 11.0 days; p = 0.019) favored laparoscopy.
  
  
  CONCLUSIONS
  Our data suggest that selective emergency laparoscopy for colon cancer is not inferior to open surgery with regard to short- and long-term outcomes. Laparoscopy resulted in a shorter length of hospital stay.
authors.affiliation: Minimally Invasive Colorectal Unit (MICRU), Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK. manfred.odermatt@gmx.ch
authors.forename: Manfred
authors.initials: M
authors.lastname: Odermatt
authors.forename: Danilo
authors.initials: D
authors.lastname: Miskovic
authors.forename: Najaf
authors.initials: N
authors.lastname: Siddiqi
authors.forename: Jim
authors.initials: J
authors.lastname: Khan
authors.forename: Amjad
authors.initials: A
authors.lastname: Parvaiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult