Colonoscopy Assisted Laparoscopic Wedge Resection for Colonic Lesions: Impact on Quality of LifE: Results from the LIMERIC Study.

Abstract

Background: The LIMERIC study has proven that colonoscopy-assisted laparoscopic wedge resection effectively and safely removes benign colonic lesions unsuitable for endoscopic removal, thereby avoiding the need for major surgery.

Objective: To evaluate the impact of colonoscopy-assisted laparoscopic wedge on health-related quality of life of patients who participated in the LIMERIC study.

Design: Prospective multicenter study.

Settings: The LIMERIC study was performed between 2016 and 2020 in 13 Dutch hospitals. EQ-5D-5L questionnaires were administered at baseline and 3 months after the procedure.

Patients: Patients with incomplete pre- or postoperative questionnaires or those undergoing combined interventions were excluded from the intention-to-treat analysis. Those for whom CAL-WR was not feasible or who underwent completion surgery were excluded from the per-protocol analysis.

Intervention: Colonoscopy-assisted laparoscopic wedge for either (1) colon polyp unsuitable for endoscopic resection; (2) non-lifting residual or recurrent polyp within scar tissue following previous polypectomy; or (3) Rx/R1 endoscopic removal of a low-risk pT1 colon carcinoma.

Main outcome measures: Three-month health-related quality of life.

Results: Colonoscopy-assisted laparoscopic wedge did not affect health-related quality of life in the per-protocol analysis (n = 56), or in the intention-to-treat analysis (n = 67). The majority of patients reported no change in health status (57%). No significant differences were observed in the distribution of responses across all 5 dimensions before and after colonoscopy-assisted laparoscopic wedge. Patients' self-rated EQ-VAS was also unaffected by colonoscopy-assisted laparoscopic wedge, with a median VAS score of 82.5 at baseline and 80 after surgery in the per-protocol analysis (p = 0.63).

Limitations: Solely a patient-reported outcome measure evaluating global health-related quality of life was used, rather than one specifically assessing disease-related quality of life, such as the QLQ-CR29.

Conclusions: Colonoscopy-assisted laparoscopic wedge has no significant impact on the health-related quality of life in patients with benign colonic lesions and should therefore be considered before major surgery is performed. See Video Abstract.