Pregnancy Outcomes Following Laparoscopic-Assisted and Open Colorectal Cancer Surgery

F A Haggar, PhD MPH, D B Preen, PhD, K Einarsdottir, PhD, R P Boushey, PhD MD, J Mamazza, MD. The Ottawa Hospital, The University of Ottawa; The School of Population Health, The University of Western Australia

OBJECTIVE: The purpose of this study was to investigate the pregnancy outcomes of patients who had previous open or laparoscopic-assisted surgery for colorectal cancer.

METHODS AND PROCEDURES: A population-based linked data study, combining data from the Western Australia Midwives Notification System and Western Australia Cancer Registry, was performed to compare outcomes for all pregnancies of patients who underwent surgical treatment for colorectal cancer during the period 1983 – 2007. Stratified analyses with the Mantel-Haenszel technique and a multiple logistic regression model were performed to investigate the association between colorectal surgery and a range of birthing outcomes while controlling for multiple clinical and socio-demographic confounders.

RESULTS: Of the 627,762 live births during the study period, 232 deliveries were to patients who had previously undergone either laparoscopic-assisted (n=79) or open surgery (n=153) for colorectal cancer. The following factors were significantly associated with a previous colorectal cancer surgery: caesarean delivery (OR=1.4; 95% CIs, 1.1-2.1; P=0.024), fertility treatments (OR= 2.2; 95%CIs,1.7-3.8; P<0.001), premature rupture of membranes (odds ratios, 1.9; 95% confidence interval, 1.3-2.7; P=0.001), labor induction (odds ratios, 2.2; 95% CI, 1.7-2.8; P<0.001) and fetal macrosomia (birth weight >4 kg; odds ratios, 2.1; 95% CI,1.4-3.0; P<0.001). Comparison between the open and laparoscopic-assisted colorectal surgery group revealed significantly higher proportion of Caesarean delivery among women who had previous open surgery compared with those women who had laparoscopic-assisted surgery (25.2% vs. 12.2%; odds ratios, 2.4; 95% CI, 1.9-3.1; P<0.001). Even after controlling for multiple possible confounders the association between open colorectal surgery and Caesarean delivery remained statistically significant. No significant differences were noted between the groups regarding other pregnancy complications such as placental abruption, placenta previa, labor dystocia, or perinatal complications (such as meconium-stained amniotic fluid, perinatal mortality, congenital malformations and low Apgar scores at 1 and 5 minutes).

CONCLUSION: Women who had colorectal cancer surgery were significantly more likely to experience adverse perinatal outcomes compared with women who did not undergo surgery. Perinatal outcomes were similar between patients undergoing laparoscopic-assisted and open surgeries, except women who had previous open colorectal surgery were at significantly higher risk of Caesarean delivery.