• Lieke Gietelink, Michel W J M Wouters, Willem A Bemelman, Jan Willem Dekker, Rob A E M Tollenaar, Pieter J Tanis, and Dutch Surgical Colorectal Cancer Audit Group.
• *Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands †Department of surgical oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands ‡Department of surgery, Academic Medical Center, Amsterdam, The Netherlands §Department of surgery, Reinier de Graaf Groep, Delft, The Netherlands.
• Ann. Surg. 2016 Jul 1; 264 (1): 135-40.

ObjectivesTo evaluate the impact of a laparoscopic resection on postoperative mortality after colorectal cancer surgery.BackgroundThe question whether laparoscopic resection (LR) compared with open surgery [open resection (OR)] for colorectal cancer influences the risk of postoperative mortality remains unresolved. Several meta-analyses showed a trend but failed to reach statistical significance. The exclusion of high-risk patients and insufficient power might be responsible for that. We analyzed the influence of LR on postoperative mortality in a risk-stratified comparison and secondly, we studied the effect of LR on postoperative morbidity.MethodsData from the Dutch Surgical Colorectal Audit (2010-2013) were used. Homogenous subgroups of patients were defined on the basis of factors influencing the choice of surgical approach and risk factors for postoperative mortality. Crude mortality rates were compared between LR and OR. The influence of LR on postoperative complications was evaluated using both univariable and multivariable analyses.ResultsIn patients undergoing elective surgery for nonlocally advanced, nonmetastasized colon cancer, LR was associated with a significant lower risk of postoperative mortality than OR in 20/22 subgroups. LR was independently associated with a lower risk of cardiac (odds ratio: 0.73, 95% confidence interval: 0.66-0.82) and respiratory (odds ratio: 0.73, 95% confidence interval: 0.64-0.84) complications.ConclusionsLR reduces the risk of postoperative mortality compared with OR in elective setting in patients with nonlocally advanced, nonmetastasized colorectal cancer. Especially elderly frail patients seem to benefit because of reduced cardiopulmonary complications. These findings support widespread implementation of LR for colorectal cancer also in patients at high operative risk.

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