Cigdem Benlice, Ahmet Rencuzogullari, James Church, Gokhan Ozuner, David Liska, Scott Steele, Emre Gorgun. Cleveland Clinic
Background: Intraoperative colonoscopy (IOC) is an adjunct in colorectal surgery (CRS) especially in patients with malignancies in order to detect location of the primary or synchronous lesions as well as assessing anastomotic integrity. However, effects of intraoperative colonoscopy on short term outcomes during CRS is a concern. This study aims to evaluate safety and feasibility and post-operative outcomes of intraoperative colonoscopy in left-sided colectomy patients for colorectal cancer patients by using the nationwide database.
Patients and Methods: Patients undergoing elective left-sided colectomy with low pelvic anastomosis without any proximal diversion for colorectal cancer were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) procedure-targeted database (2013-2015) according to their primary procedure Current Procedural Terminology (CPT) code. Subsequently, patients who underwent intraoperative colonoscopy were identified from concurrent CPT codes and divided into two groups based on the simultaneous intraoperative colonoscopy. Demographics, comorbidities, 30-day postoperative complications were evaluated and compared between the groups. Multivariate logistic regression was conducted adjusting for significant factors between the groups.
Results: A total of 5579 patients were identified and IOC was performed for 651 (11.7%) patients. The groups were comparable in terms of demographics, characteristics and operative factors except for surgical approach (laparoscopic surgery: 85.8% vs 75.2%, p<0.001), mechanical bowel preparation (71.7% vs 75.8%, p=0.03), oral antibiotic use with bowel preparation (32.8% vs. 39.5%, p=0.002) and preoperative chemotherapy within 90 days (15.6% vs. 18.9%, p=0.04). Comparison of individual postoperative complications and length of stay were summarized in the table. After multivariate risk-adjustment, the results did not change and groups remain comparable.
Conclusion: Use of intraoperative colonoscopy does not adversely affect short term outcomes after colorectal resections. Surgeons should utilize intraoperative colonoscopy liberally for left sided colorectal resections.
Table: Comparison of postoperative outcomes between patients who had colonoscopy or not
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88537
Program Number: P231
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster