Natural history of right hemicolectomy for cancer in high-risk anesthetic patients: Immediate anastomosis is a valid option.

Abstract

Introduction: Surgeons and patients need to know the expected outcomes of right hemicolectomy for colon cancer in high-risk anesthetic patients.

Methods: This is a two-center study of high-risk anesthetic patients undergoing right hemicolectomy between 2009 and 2023. High-risk anesthetic patients were defined as those with ASA score≥3. The primary endpoint was to assess the safety of right hemicolectomy evaluated as 90-day mortality and morbidity. Secondary endpoints included the occurrence of anastomotic leak, a textbook outcome and long-term survival. Factors associated with textbook outcome and definitive stoma were also investigated.

Results: A total of 220 patients were included (mean age: 76±9 years). Of these, 8.6% of patients had a definitive stoma. Mortality and severe morbidity at 90 days were 7.3% and 14.6%, respectively. Readmission rate within 90 days was 15.9%. The rate of textbook outcome was 68.2%. In multivariable analysis, hemicolectomy without anastomosis was associated with a lower textbook outcome rate (OR=0.4, 95% CI=0.2-1.0; P=0.04) and a higher definitive stoma rate (OR=103, 95% CI=9-1131; P=0.0001) after right hemicolectomy.

Conclusions: Right hemicolectomy with immediate anastomosis in high-risk anesthetic patients with colon cancer is safe and effective with acceptable mortality and morbidity. Performing right hemicolectomy without anastomosis was a factor for failing to achieve textbook outcome and a risk factor for definitive stoma.