Alipouriani Ali, Erkaya Metincan, Sancheti Himani, Erozkan Kamil, Schabl Lukas, Sommovilla Joshua, Valente Michael, Steele Scott R, Gorgun Emre
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
J Surg Res. 2025 Feb;306:449-456. doi: 10.1016/j.jss.2024.12.046. Epub 2025 Jan 24.
In the United States, while most nonmalignant polyps are effectively treated through endoscopic removal, colectomy remains a treatment option for selected cases of nonmalignant polyps (NMPs) and colon cancer. This study aimed to compare postoperative outcomes for colectomies in these two conditions, hypothesizing similar complication rates.
We conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2021, including patients who underwent elective colectomies for colon cancer or NMPs. Using a 2:1 propensity score matching for demographics, American Society of Anesthesiologists classification, surgical methods, and comorbidities, we evaluated outcomes such as 30-d mortality, complications, anastomotic leakage, and hospital stay duration.
A total of 47,960 patients, including 30,549 colon cancer patients and 17,411 NMP patients, were included after propensity score matching analysis. We concluded that there was no significant difference in mortality and reoperation rates which were 0.6% and 3.3% in patients undergoing colectomy with colon cancer, compared to 0.5% and 3.1% in those with NMP, respectively [P = 0.64, P = 0.21,]. In addition, the anastomotic leak rates were remarkably similar in both the colon cancer (2.4%) and NMP (2.2%) groups. [P = 0.13]. Most of the 30-d postoperative surgical complications, such as sepsis, septic shock, wound disruption, and urinary tract infection exhibited similar incidence rates, however, some of them, such as readmission, pulmonary embolism, and length of stay, varied between the groups.
Our findings underscore the similar postoperative outcomes between colon cancer and NMP groups, advocating for consideration of advanced endoscopic techniques for NMPs to potentially enhance patient care and outcomes.
在美国，虽然大多数非恶性息肉可通过内镜切除得到有效治疗，但结肠切除术仍是部分非恶性息肉（NMP）和结肠癌病例的治疗选择。本研究旨在比较这两种情况下结肠切除术后的结果，假设并发症发生率相似。
我们对美国外科医师学会国家外科质量改进计划数据库2015年至2021年的数据进行了回顾性分析，纳入因结肠癌或NMP接受择期结肠切除术的患者。通过对人口统计学、美国麻醉医师协会分级、手术方法和合并症进行2:1倾向评分匹配，我们评估了30天死亡率、并发症、吻合口漏和住院时间等结果。
经过倾向评分匹配分析，共纳入47960例患者，其中结肠癌患者30549例，NMP患者17411例。我们得出结论，死亡率和再次手术率无显著差异，结肠癌患者接受结肠切除术的死亡率和再次手术率分别为0.6%和3.3%，NMP患者分别为0.5%和3.1%[P = 0.64，P = 0.21]。此外，结肠癌组（2.4%）和NMP组（2.2%）的吻合口漏率非常相似[P = 0.13]。术后30天的大多数手术并发症，如败血症、感染性休克、伤口裂开和尿路感染，发生率相似，然而，其中一些并发症，如再次入院、肺栓塞和住院时间，在两组之间有所不同。
我们的研究结果强调了结肠癌组和NMP组术后结果相似，提倡考虑对NMP采用先进的内镜技术，以潜在地改善患者护理和结果。
