Hyun Woo Bae, Jeonghee Han, Byung Soh Min. Department of Surgery, Severance Hospital, Yonsei University College of Medicine
Background: In recent years, critical pathway (CP) has been applied to the majority of the colorectal cancer patient who has minimal invasive surgery (laparoscopic surgery, robot assisted surgery). The aim of this study is to evaluate the advantage of CP and to ascertain whether combining minimally invasive surgery and CP have additional value within colorectal surgery.
Methods: We evaluated 1099 consecutive cases of colorectal cancer surgery between January 2010 and December 2012 retrospectively. Of these, the group A (CP group) was the colorectal cancer patients (N=711) who received the elective colorectal cancer surgery and postoperative care of CP, and the group B (Non-CP group) was the colorectal cancer patients (N=388) who was not indicated to CP during the same period. To overcome selection bias, we used propensity score matching to achieve a one-to-one CP group: Non-CP group ratio.
Results: After propensity score matching, 338 patients were included in each group. Baseline characteristics did not differ between the groups. The median (interquartile range) length of hospital stay was 11 (9–14) days in the group B and 7 (6–8) days in the group A, i.e., a four-day reduction (p < 0.001) in the CP group. The overall incidence of postoperative complication according to the Clavien-Dindo classification was 8 % in the group A and 4.7 % in the group B, respectively (p = 0.11). The value of preoperative prognostic nutritional index (PNI) was no difference between the group A and group B (50.1 vs. 49.2, p = 0.07), however, postoperative PNI of group A is higher than group B (47.2 vs. 46.0, p = 0.01). There were no significant differences in the other variants that searched. Median disease free survival (DFS) was 34 (range, 0–60) months and median overall survival (OS) was 36 (range, 0–60) months. In the survival analysis, there was no significant difference in DFS (86.7% vs. 84.3%, p=0.36). However, a significant difference in OS was observed in between group A and group B (97.3% vs. 93.2%, p= 0.01).
Conclusion: The CP for colorectal surgery helped to reduce the length of postoperative hospital stay without adversely affecting morbidity. The group that applied CP has benefit in postoperative PNI and overall survival. These results indicate that CP may be feasible and effective in patients with colorectal cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79120
Program Number: P181
Presentation Session: Poster (Non CME)
Presentation Type: Poster