Association between body mass index and short-term outcomes of laparoscopic right hemicolectomy for colon cancer.

BACKGROUND: Laparoscopic right hemicolectomy can be technically challenging in patients with increased body mass index, reportedly associated with higher surgical site infection (SSI) and incisional hernia rates. We aimed to assess the association between increased body mass index and short-term outcomes of laparoscopic right hemicolectomy. METHODS: This retrospective cohort study included patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Patients were managed with a standardized care protocol that comprised preoperative, intraoperative, and postoperative measures and were divided according to body mass index-normal body mass index (18-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (≥30 kg/m2). Body mass index groups were compared for baseline characteristics and outcomes. The main outcome measures were operative time, hospital stay, 30-day complications, reoperation, number of harvested lymph nodes, and resection status. RESULTS: A total of 270 patients (50% male sex; mean age: 68.7 ± 13.5 years) were included-28.5% had normal body mass index, 47% were overweight, and 24.5% had obesity. Mean operative times in obese and overweight patients were significantly longer than patients with normal body mass index (172.1 and 168.8 versus 143.3 minutes, P = .01). Compared to normal body mass index, obesity was associated with significantly higher odds of incisional SSI (odds ratio: 9.29, P = .039). Body mass index had a significant positive correlation with operation time (r = 0.205, P = .004) and incisional SSI (r = 0.126, P = .04). Body mass index groups had similar hospital stays, 30-day complications and mortality, anastomotic leak, ileus, and reoperation. CONCLUSION: Patients with increased body mass index had longer operative times and higher SSI rates, yet similar hospital stays and comparable 30-day complication rates, mortality, and reoperation to patients with normal body mass index.

Predictors and Impact of Ileus on Outcomes After Laparoscopic Right Colectomy: A Case-Control Study.

BACKGROUND: Ileus is a common complication of major abdominal surgery, including colorectal resection. The present study aimed to assess the predictors of ileus after laparoscopic right colectomy for colon cancer. METHODS: This study was a retrospective case-control analysis of a prospective IRB-approved database of patients who underwent laparoscopic right colectomy at the Department of Colorectal Surgery, Cleveland Clinic Florida. Patients who developed ileus after right colectomy were compared to patients without ileus to determine the risk factors of ileus. RESULTS: The present study included 270 patients with a mean age of 68.7 years. Thirty-six patients (13.3%) experienced ileus after laparoscopic right colectomy. The median duration of ileus was 6 days. Factors associated with ileus were age (71.6 vs 68.2 years, P = .158), emergency colectomy (11.1% vs 3.9%, P = .082), extended hemicolectomy (19.4% vs 6.8%, P = .021), green gastrointestinal anastomosis (GIA) 4.8mm staple height cartridge (19% vs 8.1%, P = .114), and longer operative time (177.9 vs 160.4 minutes, P = .157). The only independent predictor of ileus was extended colectomy (OR: 16.7, P = .003). CONCLUSIONS: Increased age, emergency surgery, green GIA cartridge, and longer operative times were associated with ileus, yet the only independent predictor of ileus was extended right hemicolectomy.

Stapler size independently predicts postoperative complications following stapled ileocolic anastomosis: A retrospective cohort study.

AIM: Staplers used in ileocolic anastomosis construction differ in length and height. We assessed the impact of stapler type in creating ileocolic anastomoses on postoperative outcomes. METHODS: This retrospective cohort study of an Institutional Review Board approved database included patients who underwent laparoscopic right colectomy for cancer between January 2011 and August 2021. All patients had construction of extracorporeal antiperistaltic stapled ileocolic anastomosis using a linear cutting stapler. Main outcome measures were short-term (<30 day) morbidity and mortality. RESULTS: In all, 270 patients (136 men; median age 70.2 years) were included. A 75 mm stapler was used in 49 (18.1%) patients, 80 mm in 97 (35.9%) and 100 mm in 124 (45.9%). Blue cartridge (stapler height 3.5 mm) was used in 175 (64.5%) and green cartridge (4.8 mm) in 18 (7%) patients; this information was unavailable in 77 (28.5%) cases. Apical enterotomy closure was performed by linear stapler in 54% and linear cutting stapler in 46%. Apical staple line reinforcement or imbrication suturing was used in 26.3%. The overall postoperative complication rate was 28.9%. The anastomotic leak rate was 2.6%. Independent predictors of complications after laparoscopic right colectomy were older age (OR 1.03, 95%CI 1-1.06; P = 0.01), extended colectomy (OR 2.76, 95%CI 1.07-7.08; P = 0.035) and emergency surgery (OR 4.5, 95%CI 1.3-14.9; P = 0.014). A 100-mm linear cutting stapler was an independent protective factor against postoperative complications (OR 0.3, 95%CI 0.18-0.85; P = 0.019). Stapler height and closure technique of apical enterotomy did not affect postoperative complications. CONCLUSION: Independent predictors of complications after laparoscopic right colectomy were older age, extended colectomy and emergency surgery. Using a 100 mm stapler was an independent protective factor against postoperative complications.