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Session: ePoster Monitor 3-Quality and Cost 1

eP144 - Subtotal Colectomy versus Left Colectomy: Does Extent of Resection Affect Outcomes?

Sunday, June 2, 2024
8:24 AM – 8:29 AM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • BC

    Beatrix H. Choi, MD

    Resident Physician
    Columbia-NYP Department of Surgery
    Columbia University Medical Center
    New York, NY, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • OJ

    Osama Jabi, MD

    Postdoctoral Research Fellow
    Columbia University Irving Medical Center
    New York, New York, United States

    Disclosure information not submitted.

  • DK

    Dilara Khoshknabi, MD

    Consultant
    Columbia University Medical Center
    Cleveland, Ohio, United States

    Disclosure information not submitted.

  • Marco Zoccali, MD

    Associate professor of surgery
    Columbia university
    Columbia University
    New york, New York, United States

    All relevant financial disclosures have been managed and will be listed below.
    This individual has no financial relationships with ineligible companies.

  • JC

    James Church, MD

    Professor of Surgery
    Columbia University Medical Center
    New York, New York, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • RK

    Ravi Kiran, MBBS

    Colorectal Surgeon
    Columbia University Medical Center
    New York, New York, United States

    Disclosure information not submitted.

Purpose/Background: Total and subtotal abdominal colectomy are more extensive procedures than a standard left colectomy and involve an ileorectal or ileocolic anastomosis. These factors may contribute to higher rates of morbidity and mortality. We sought to study outcomes after subtotal/total colectomy compared to left colectomy.Methods/Interventions: All patients undergoing subtotal (ileosigmoid anastomosis)/total (ileorectal anastomosis) colectomy (S/T group), or left colectomy (L group) with primary anastomosis between 2013 and 2022 were identified via a prospectively maintained database at an academic institution. The following data were collected: patient demographics; comorbidities; surgical characteristics including laparoscopy, intraoperative complications, estimated blood loss (EBL), and American Society of Anesthesiologists (ASA) class; and postoperative outcomes including length of stay (LOS), readmission, reoperation, mortality, and individual postoperative complications. The two groups were matched 1:1 on age, gender, body mass index (BMI), and use of laparoscopy. Data were analyzed using the Wilcoxon sum-rank test and chi-squared test for univariate and logistic or linear regression for multivariate analysis.Results/Outcomes: There were 102 S/T patients and 745 L patients. After matching, the 204 patients had a median age of 53.7 years with an interquartile range (IQR) of 42–66. Median BMI was 25.8 (IQR 21.9–29.4), 130 (64%) were female, and 168 (82%) underwent laparoscopic surgery. The two groups were similar in most comorbidities, but more of S/T had diabetes (20 vs 8%, P=0.03). Indication for surgery differed for the two groups, with the majority of S/T undergoing surgery for cancer (38%) or constipation (38%) while L mostly underwent surgery for cancer (32%) or diverticulitis (53%) (P < 0.0001). More S/T cases were classified as clean or clean-contaminated (78 vs 60%, P=0.006). Conversion to open surgery (14 vs 6%, P=0.09) and intraoperative complications (13 vs 6%, P=0.15) were similar. EBL was higher for S/T (median 100 [IQR 30–188] vs 50 mL [IQR 12.5–100], P=0.02). Postoperative complications are shown in Table 1. There was a trend to higher rates of reoperation, anastomotic leak, and ileus in the S/T group. There were significant differences in LOS (S/T 6.8 vs L 4.5 days, P=0.0002) and higher readmission rate (S/T 22 vs L 7%, P=0.005). However, when controlling for pre- and intra-operative differences, only prolonged LOS was associated with S/T (coefficient estimate=2.7, 95% CI [0.57, 4.9], P=0.01). Higher EBL was predictive of reoperation (P=0.02) while diabetes was predictive of readmission (P=0.03).Conclusion/

Discussion: These data suggest that while subtotal or total abdominal colectomy can be performed with relatively low morbidity and mortality, when compared to segmental colectomy, complication rates tend to be higher and length of stay longer.Table 1. Characteristics and Postoperative Outcomes of Subtotal/Total and Left ColectomyComparing the perioperative characteristics and outcomes of S/T and L groups. SSI: surgical site infection; UTI: urinary tract infection; VTE: venous thromboembolism