Impact of a minimally invasive approach for colon cancer surgery on outcomes in patients with functional limitations.

Introduction: Patients with functional dependence have poorer outcomes after surgery for colon cancer than those who are independent. We sought to determine how much the use of minimally invasive surgery (MIS) would reduce the impact of functional dependence on discharge home, 30-day readmission, and 30-day mortality.

Methods: We used the 2012-2020 American College of Surgeons' National Surgical Quality improvement Program data on patients who underwent colectomies for colon cancer. Functional dependence was either independent, partially/totally dependent, or unknown. Surgical approaches were either MIS or open. We constructed logistic regression models to analyze the data and used a counterfactual approach to assess the differences in predicted rates of outcome for open vs. MIS surgery.

Results: 2.7% of 115,897 patients were partially/totally dependent. While 64.5% of all patients received MIS, among those who were partially/totally dependent only 49.7% received MIS. No difference existed in discharge destination or readmission rate by surgical approach among patients who were partially/totally dependent (p = 0.384 and p = 0.168, respectively). Using the counterfactual approach, performing MIS rather than open surgery among patients who were partially/totally dependent would lower 30-day mortality by 27.3% (relative reduction).

Discussion: Optimizing MIS in patients with functional limitations should be a priority in colon cancer resection.