Minimally invasive approach to resection surgery in right sided malignant obstruction improved short-term outcomes – a population-based cohort study

Abstract Introduction Minimally invasive surgery (MIS) improves short-term outcomes in elective colectomy, however, its current utilization in an emergency setting is limited. Malignant obstruction is the most common indication for emergency right sided colectomy. The current study aims to assess short-term outcomes of MIS in these patients. Method Patients undergoing emergency right sided colectomy in Sweden between 2017 and 2023 were identified through the Swedish ColoRectal Cancer Registry. Outcome measures included length of stay (LOS), complication rate and surgical quality indicators, and were analyzed on intention to treat. Result In total 1147 patients fulfilled inclusion criteria. Open resection (OPEN) was completed in 94.3%(n=1082) and MIS resection in 5.7%(n=65) of patients. The conversion rate was 34% (n=34/99). Age, sex, BMI, ASA and tumour characteristics were similar between groups. LOS was shorter after MIS, 6 (IQR 4-8) compared to 8 (IQR 6-13) days in OPEN. Univariable and multivariable survival analysis showed significant advantage for MIS; HR 0.64 (95% CI 0.49-0.83, p<0.001); HR 0.67 (95% CI 0.51-0.87, p=0.002), respectively. Post-operative complication rate after OPEN and MIS were 35.3% and 21.5%, respectively (p=0.026). In regression analysis of factors affecting postoperative complications; ASA-classification, male gender, and permanent ostomy had a statistically significant effect on this outcome. MIS had no significant impact on overall complications in step-wise regression analysis; OR 0.57 (95% CI 0.31-1.05, p=0.07). Non-inferiority analysis of surgical quality indicators did not show inferiority of the MIS approach. Discussion Emergency MIS might offer short-term benefits in patients with malignant right sided obstruction.