Longer Operative Time: Deterioration of Clinical Outcomes of Laparoscopic Colectomy Versus Open Colectomy

BACKGROUND: As laparoscopic surgery is applied to colorectal surgery procedures, it becomes imperative to delineate whether there is an operative duration where benefits diminish. OBJECTIVE: The purpose of this work was to determine whether benefits of a laparoscopic right colectomy compared with an open right colectomy are diminished by prolonged operative times. DESIGN: We performed a retrospective analysis comparing outcomes of patients undergoing laparoscopic right and open right colectomy for colon cancer with operative duration of less than and greater than 3 hours. SETTINGS: This study was based on data in the American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS: We queried the database for patients with laparoscopic and open right colectomy with a diagnosis of colorectal cancer between 2005 and 2010. MAIN OUTCOME MEASURES: Patients were stratified by operative technique and duration. Forward multivariable logistic regression analysis was performed for mortality, cerebrovascular/cardiovascular complications, and infectious complications. Predictors of operative time >3 hours in the laparoscopic cohort were identified by logistic regression. RESULTS: Of 4273 patients, operative duration was >3 hours for 18.4% of patients with a laparoscopic right colectomy and 11.3% with an open right colectomy. There was no benefit of the laparoscopic right colectomy with an operative duration >3 hours over open right colectomy with respect to mortality and cardiopulmonary and cerebrovascular complications. An operative duration >3 hours was an independent risk factor for infectious complications in patients undergoing a laparoscopic right colectomy. LIMITATIONS: This was a retrospective study and not an intention-to-treat analysis. CONCLUSIONS: At an operative duration of >= 3 hours, laparoscopic right colectomy has higher infectious complications than open right colectomy. Reduced mortality and less cardiopulmonary and cerebrovascular complications seen in the laparoscopic cohort with shorter operative duration were lost with an operative duration >3 hours. In patients at risk for prolonged laparoscopic right colectomy, early conversion to an open technique may be warranted.