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Session: ePoster: Quality and Cost 4 (Mon8)

EP651 - Comparative Analysis of Surgical Techniques for Right and Left Colectomy: Impact of Body Mass Index on Postoperative Outcomes

Monday, May 12, 2025
8:21 AM – 8:26 AM PT
Location: Monitor 7, Sails Pavilion, Upper Level

    Author(s)

  • JL

    Jose D. Llaque Salazar, MD

    Resident Physician
    Univeristy of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • ePoster Presenter(s)

  • Laura C. Perez Arteaga, MD

    Resident Phycisian
    University of Colorado School of Medicine
    Denver, CO, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • OT

    Otto Thielen, MD

    Resident Physician
    University of Colorado School of Medicine
    Denver, Colorado, United States

    Disclosure information not submitted.

  • SB

    Sara Byers, MS

    Data Analyst
    University of Colorado School of Medicine
    Denver, Colorado, United States

    Disclosure information not submitted.

  • MM

    Martin McCarter, MD

    Professor Of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    Disclosure information not submitted.

  • Jon D. vogel, MD

    Professor
    University of Colorado School of Medicine
    University of Colorado
    Aurora, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • AM

    Amber Moyer, MD

    Assistant Professor of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • BM

    Benedetto Mungo, MD

    Assistant Professor of Surgery
    University of Colorado School of Medicine
    Denver, Colorado, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Jose D. Llaque Salazar, MD: This individual has no financial relationships with ineligible companies.
Laura C. Perez Arteaga, MD: This individual has no financial relationships with ineligible companies.
Jon D. vogel, MD: This individual has no financial relationships with ineligible companies.
Amber Moyer, MD: This individual has no financial relationships with ineligible companies.
Benedetto Mungo, MD: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: As obesity rates rise, surgeons increasingly face the challenge of operating on this population, often with higher risks of postoperative complications. Minimally invasive surgery (MIS) has emerged as a promising technique for patients with higher BMI, with several advantages such as decreased length of stay and reduced incisional complications. Comprehensive comparative data on surgical techniques between normal weight and obese patients remain limited. We aimed to evaluate whether surgical outcomes of different approaches (open, laparoscopic, and robotic) for right and left colectomy differ between normal weight and obese patients.

Methods/Interventions: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we analyzed patients undergoing right and left colectomy. Patients were stratified by BMI (normal/overweight: 18-29.9, obese: ≥30) and surgical approach. Primary outcomes included overall morbidity, anastomotic leakage, and lymph node retrieval. Multivariable analysis was performed adjusting for baseline characteristics.

Results/Outcomes:

Results: Of 32,047 patients undergoing left colectomy, 36,1% were obese. MIS approaches (51.8% laparoscopic, 18% robotic) showed lower overall morbidity compared to open surgery (30.1%) (13.43% and 12.25% vs 24.89%, p< 0.0001). Both MIS approaches reduced morbidity risk (OR=0.79, p< 0.0001), anastomotic leak rates (p < 0.0001), and had higher number of nodes retrieved (p < 0.0001). Obesity was related with increased probability of mortality and morbidity (p=0.01 and p< 0.0001), and lower number of nodes evaluated (p < 0.0001). Multivariable analysis revealed MIS approaches reduced overall morbidity (OR=0.79, p< 0.0001) and improved lymph node harvest (OR=1.02-1.03, p≤0.044). Laparoscopic surgery was associated with lower anastomotic leak risk (OR=0.81, p< 0.0001). BMI did not significantly impact these outcomes.

Of 13373 patients undergoing right colectomy, 36,2% were obese. MIS approaches (55.6% laparoscopic, 10.6% robotic) showed lower overall morbidity compared to open surgery (33.7%) (16.3% and 15.4% vs 26.92%, p< 0.0001). Compared to open surgery, both MIS approaches showed lower odds of overall morbidity (open 26.92%, laparoscopic 16.3%, robotic 15.4%, p< 0.0001), lower anastomosis leak (p=0.0006), and increased number of nodes retrieved p< 0.0001). Obesity increased mortality and overall morbidity risk (p < 0.0001) and lowered lymph node harvest (p=0.0001), but didn't affect leak rates (3.58 vs. 3.4%, p=0.37). Multivariable analysis showed MIS reduced overall morbidity (robotic OR=0.84, p< 0.0001, laparoscopic OR=0.81, p≤0.0019). Laparoscopic was associated with lower anastomotic leak risk (OR=0.79, p=0.0079), while robotic approach improved lymph node harvest (OR=1.04, p=0.012). BMI didn't affect these outcomes.

Conclusion/Discussion: MIS techniques demonstrated improved outcomes for left and right colectomy, showing lower overall morbidity and anastomotic leakage compared to open surgery, as well as particular benefit in lymph node retrieval for both. While obesity impacted lymph node retrieval, it did not significantly affect overall morbidity or leak risk when adjusted for surgical technique. These findings suggest that open right and left colectomy may be perfumed on obese patients with same morbidity and mortality as with MIS techniques.