Morbidity, mortality, and risk factors after laparoscopic and open surgery for T1-T2 colon cancer

Abstract Introduction Surgical resection is the primary treatment for colon cancer (CC), though minimally invasive alternatives are increasingly used for T1-T2 disease. This study aims to compare 30-day morbidity and mortality following laparoscopic surgery (LS) and open surgery (OS) for T1–T2 CC, assess stoma frequency, and identify risk factors for morbidity. Method Retrospective nationwide cohort based on the Swedish Colorectal Cancer Registry including patients undergoing elective right hemicolectomy, transverse resection, left hemicolectomy, and sigmoid resection for T1-T2N0M0 CC between 2011-2020. Complications were classified using the Clavien-Dindo (CD) system: CD≥II for overall morbidity, and CD≥IIIb severe complications. Risk factors were analysed using multivariate logistic regression. Result Of 4241 patients, 2252 (53%) had OS, and 1989 (47%) had LS. Thirty-day mortality was 1.4% after OS and 1.0% following LS (p=0.17). OS was associated with higher morbidity (27% vs. 21%; adjusted odds ratio [aOR] 1.33) and severe complications (9% vs. 7%; aOR 1.32). Surgical morbidities were the most common complication type, affecting 555 patients, with CD≥IIIb graded seen in 8% and 6% following OS and LS, respectively (p<0.05). Male sex increased the risk for overall (aOR 1.47) and severe morbidity (aOR 1.68). ASA≥3 and BMI≥30 were also independent risk factors for both outcomes. Stoma formation was more frequent during OS (128) than LS (47; p<0.05). Discussion OS was associated with higher overall and severe morbidity, and stoma formations than LS. Male sex, ASA≥3, and obesity were independent risk factors for both outcomes. Mortality was low and comparable across approaches.