title: Decreased risk of surgery for small bowel obstruction after laparoscopic colon cancer surgery compared with open surgery: a nationwide cohort study.
abstract: The impact of surgical approach on the incidence of small bowel obstruction (SBO) is unclear. The aim of the current study was to analyze the long-term risk of surgery for SBO after open and laparoscopic surgery and to assess how subsequent SBO surgery impacts on mortality after colonic cancer resection.
  
  
  
  This was a nationwide cohort study of patients undergoing elective colonic cancer resection with primary anastomosis in Denmark between 2001 and 2008. All included patients were operated with curative intent. Patients were identified in the Danish Colorectal Cancer Group database and followed through May 2014 in the Danish National Patient Register. The primary endpoint was surgery for SBO. Secondarily, mortality among patients who subsequently underwent SBO surgery and those who did not was compared.
  
  
  
  Among the 8583 included patients, 251 (2.9 %) underwent surgery for SBO during follow-up (median 8.8 years). The 3-year cumulative incidence of SBO surgery was 1.5 %; 1.2 % after laparoscopic and 1.6 % after open surgery. Laparoscopic surgery was associated with a decreased risk of SBO (hazard ratio [HR] 0.61 (CI 0.37 to 0.99, P = 0.048) compared with open surgery. The HR for mortality after colonic resection was 2.54 (CI 1.91 to 3.38, P < 0.001) for patients who underwent subsequent SBO surgery as compared to those who did not.
  
  
  
  Laparoscopic surgery for colonic cancer was associated with a decreased risk of subsequent SBO surgery compared with open surgery. Further, subsequent SBO surgery was associated with increased mortality after colonic cancer resection.
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark. mail@kristiankiim.dk.
authors.forename: Kristian Kiim
authors.initials: KK
authors.lastname: Jensen
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Andersen
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark.
authors.forename: Rune
authors.initials: R
authors.lastname: Erichsen
authors.affiliation: Department of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Scheike
authors.affiliation: Department of Surgery P, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark.|Danish Colorectal Cancer Group, Hvidovre, Denmark.
authors.forename: Lene Hjerrild
authors.initials: LH
authors.lastname: Iversen
authors.affiliation: Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.|Danish Colorectal Cancer Group, Hvidovre, Denmark.
authors.forename: Peter-Martin
authors.initials: PM
authors.lastname: Krarup
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000601:surgery*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012042:Registries
keywords: Adhesions; Complications; Minimally invasive; Mortality