Impact of Resection Type for Adenocarcinoma and Carcinoid Tumors of the Small Intestine: A Review of the NSQIP Dataset

Joseph Broucek, MD, Randal Zhou, MD, John Kubasiak, MD, Jennifer Poirier, PhD, Jonathan Myers, MD, FACS, Minh Luu, MD, FACS. Rush University Medical Center

INTRODUCTION: Malignancies of the small intestine are a rare entity, which have been primarily treated via open surgical resection. As the field of minimally invasive surgery continues to expand, more oncologic resections are being performed in a minimally invasive manner without sacrificing oncologic outcomes. We utilized the prospective ACS-NSQIP dataset to evaluate demographics, co-morbidities and short-term outcomes of laparoscopic versus open resection of adenocarcinoma and carcinoid tumors of the small bowel.

METHODS: The ACS-NSQIP dataset was queried for patients undergoing laparoscopic or open small bowel resection for adenocarcinoma or carcinoid tumors using primary procedure CPT codes between the years 2009-2012. Main outcomes investigated included post-operative pneumonia, pulmonary embolism, wound infection, re-bleeding, renal failure, DVT, sepsis/shock, cardiac events, neurologic events, return to operating room, and length of stay as defined by the ACS-NSQIP. Univariate and multivariate analyses were used to investigate these outcomes as well as demographics for patients undergoing open or laparoscopic (lap) resection.

RESULTS: Regarding adenocarcinoma of the small bowel, 594 cases were identified with 14% of resections performed laparoscopic and 86% of resections performed via open technique. Age was significantly different at 40.1 years old for the laparoscopic group and 44 years old for the open group (p=0.02). Sex was evenly distributed: 56.4% male vs 43.6 % female (p=0.06). When using Fisher’s exact test, there was a significant different in length of hospital stay (mean lap 5.44 days [SD 2.91] vs open 8.49 [SD 5.61], p=0.000000006). Regarding carcinoid of the small intestine, 412 cases were identified with 15% of cases performed laparoscopic and 85% open. The age was evenly distributed at an average of 47.8 years (lap 50.8 vs open 47.3, p=0.08). Sex was not significantly different (60% male vs 40% female, p=0.2). Again, using Fisher’s exact test, there was a significant difference in length of hospital stay (mean lap 5.1 days [SD 4.85] vs open 7.9 [SD 5.77], p=0.05).

CONCLUSION: There is evidence of low utilization of laparoscopy in the resection of small bowel malignancies. We show that laparoscopic resection is associated with a decreased length of hospital stay in these instances.