eP724 - Incidence of Anastomotic Leakage and Organ Space Infection Following Elective Left, Right, and Total Colectomy for Colorectal Cancer Patients

Purpose/Background: Data on anastomotic leak and organ space collection following colectomy is outdated and often bundles emergency and elective operations for various indications. Additionally, with recent advancements in minimally invasive surgery in the last decade, there is a need to evaluate anastomotic leakage (AL) incidence following different types of colectomies. As such, we used a large database to assess updated rates of AL and organ space infection following right, left, or total colectomy for cancer.Methods/Interventions: We conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2016 to 2020 and assessed the incidence of AL and organ space SSI for colorectal cancer patients undergoing left, right, or total colectomy. We further sub-analyzed and compared AL and organ space SSI incidence between patients who underwent minimally invasive or open surgery.Data were evaluated for patient characteristics, comorbidities, intraoperative characteristics, and postoperative outcomes across patients with different colectomy procedures: left, right, and total. The analysis focused on primary outcomes of AL and organ space SSI incidence. AL was defined by NSQIP as a leak of endoluminal contents through an anastomosis. All statistics were performed in SPSS Statistics 27.0. A P-value of less than 0.05 was considered to be statistically significant.Results/Outcomes: Our cohort included 10,925 patients with colorectal cancer who underwent elective colectomy with a mean age was 68 years, a mean BMI of 28 kg/m2, and 48.7% were male. Within the cohort, 5431, 5159, and 335 patients underwent right-sided, left-sided, and total colectomy, respectively. Of these patients, 58.9% underwent minimally invasive surgery for right-sided procedures, 64.3% for left-sided, and 36.5% for total colectomy, and the remainder underwent open surgery. The overall incidence rates of organ space SSI and AL were 3.03% and 2.66%, respectively.The rate of organ space SSI was 2.9%, 3.3%, and 4.5% for right, left, and total colectomy, respectively (Table 1A, p=0.2). Patients who underwent total colectomy had the highest incidence of AL compared to the left- and right-sided colectomy (4.5%, 3.3%, 2.4%, respectively, Table 1A, p=0.004). We further conducted multivariable logistic regression analysis to evaluate the associated patient characteristics, comorbidities, surgical approach, and intraoperative characteristics. Patients who underwent right-sided colectomy were 24.4% less likely to have AL compared to patients who had left-sided colectomy (Table 1B). When comparing the primary outcomes for each type of colectomy and surgical approach, patients who had minimally invasive surgery showed a significantly lower incidence of both organ space SSI (Right-sided colectomy: 4.1% for open, 2% for minimally invasive; Left-sided colectomy: 4.4% for open, 2.6% for minimally invasive) and AL (Right-sided colectomy: 3.5% for open, 1.5% for minimally invasive; Left-sided colectomy: 4.6% for open, 2.6% for minimally invasive) in left- and right-sided colectomy, but not in total colectomy (Table 1C).Conclusion/

Discussion: When considering surgical treatment of colorectal cancer, total and left-sided colectomy may pose a higher risk of anastomotic leakage but not general organ space SSI. In the case of both left- and right-sided colectomy, a minimally invasive surgical procedure can significantly reduce the risks for both organ space SSI and AL.Table 1A. Summary of organ space SSI and AL incidence for patients undergone right, left, or total colectomy from 2016-2020 Patient Database of ACS-NSQIP. B. Multivariate logistic regression finding. C.Comparing organ space SSI and AL incidence for left, right, and total colectomy with different surgical techniques.