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Session: ePoster Monitor 7-Colon Cancer 5

eP511 - Postoperative Colonic Ischemia Following Colectomy for Cancer: Risk Factors and Outcomes

Sunday, June 2, 2024
3:54 PM – 3:59 PM ET, USA
Location: Baltimore Convention Center, Room 318-320

    ePoster Presenter(s)

  • Miriannie Rivera-Valerio, MD, MS (she/her/hers)

    Resident Physician
    Howard University Hospital
    Howard University Hospital
    Washington, DC, United States

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

    • Author(s)

  • Mahin Janjua, MD (she/her/hers)

    Resident Physician
    Howard University Hospital
    Howard University Hospital
    Washington, DC, United States

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

  • AZ

    Ahmad Zeineddin, MD

    Resident Physician
    Howard University Hospital
    WASHINGTON, District of Columbia, United States

    Disclosure information not submitted.

  • AL

    Anna Lin, MD

    Resident Physician
    Howard University Hospital
    Washington, District of Columbia, United States

    Disclosure information not submitted.

  • KN

    Kindha Nasef, MD

    Resident Physician
    Howard University Hospital
    Washington, District of Columbia, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • CN

    Christine Nembhard, MD, FACS

    Assistant Professor
    Howard University Hospital
    Washington, District of Columbia, United States

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

Purpose/Background: Colonic ischemia after colectomy is rare and can have devastating consequences. Oncologic principles for cancer colectomy generally dictate high ligation of the segmental feeding vessels which increases the risk for ischemia in susceptible patients. As such, we seek to identify risk factors for colonic ischemia and the subsequent need to return to the operating room (OR) for patients undergoing colectomy for cancer.Methods/Interventions: The National Inpatient Sample was queried from 2005 to 2019 for all patients who underwent colectomy for a primary diagnosis of colorectal cancer using ICD-9 and 10 codes. Patient demographics, comorbidities, surgical resection, and outcomes were analyzed with univariate analysis of patients with and without postoperative colonic ischemia (POCI). Multivariable logistic models assessed risk factors for developing POCI, return to the OR, and mortality.Results/Outcomes: There were 127,456 patients included. Mean age was 66 ± 13 years, 47% were female, 78% White, 9% Black, and 7% Hispanic. Most patients had Medicare (53%), 37% had private insurance, 5% Medicaid, and 2% were uninsured.Types of surgical intervention were: 30% right hemicolectomy, 29% anterior resection, 18% sigmoidectomy, 9% abdominoperineal resection (APR), 8% left hemicolectomy, 5% transverse colectomy, and 1% ileocecectomy. Length of stay was 6 [4-8] days, mortality was 1.2%.Acute ischemia was seen in 0.25% of patients overall. There were higher rates of POCI in patients undergoing right-sided colectomy (ileocectomy 0.61%, right hemicolectomy 0.35%, and transverse colectomy 0.25%) than left-sided colectomy (sigmoidectomy 0.21%, anterior resection 0.16% and APR 0.17%). Return to OR for further resection was seen in 13.7% of patients who developed POCI with higher rates in the left-sided colectomy group (highest 27.6% anterior resection) and the lowest rate in right hemicolectomy 3.7%. A diverting ileostomy was performed in 71% of those patients. POCI patients had a longer length of stay (14 [7-22] vs 6 [4-8] days, p < 0.01) and higher mortality (17.5% vs 1.1%, p < 0.01).On logistic regression, risk factors for POI include male gender, peripheral vascular disease, and increased Charlson comorbidity score. Compared to right hemicolectomy (reference), left-sided resections were associated with a lower risk of POI. Left-sided resections with POI were however associated with increased risk for return to the OR when compared to right-sided resections. Age was the only risk factor for morality on logistic regression (Table 1).Conclusion/

Discussion: When compared to right-sided resections, left-sided resections showed a lower rate of POCI, but a higher rate of needing to return to the operating room for additional resection. This could be because of greater variation in the presence of a right colic artery and height of vessel ligation for anterior resection / APR for rectal cancer. Additionally, left-sided anastomoses are more prone to leak and could account for the higher rate of return to OR.Table 1: Risk factors for Developing Post-operative Colon IschemiaRisk factors for acute colonic ischemia, return to the operating room, and patient mortality.