Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Minimally invasive versus open emergency right-sided colectomy for malignant obstruction: a nationwide propensity score–matched cohort study

Agger, Erik LU orcid ; Matthiessen, Peter and Vedin, Tomas LU (2026) In World Journal of Emergency Surgery 21. p.1-11
Abstract
Abstract
Background
Minimally invasive surgery (MIS) improves short-term outcomes in elective colectomy, however, the choice of surgical approach in hemodynamically stable patients with obstructing right-sided colon cancer remains unclear in emergency settings. MIS could be considered and the present study aims to evaluate short-term outcomes of MIS in bowel obstructed patients compared with open surgery (OPEN).

Methods
A retrospective nationwide study including patients from the nationwide Swedish Colorectal Cancer Registry (SCRCR) undergoing emergency right-sided colectomy in Sweden (2017–2023) was conducted. Propensity score matching (1:1) was performed based on sex, age, ASA class, hospital size, and operative... (More)
Abstract
Background
Minimally invasive surgery (MIS) improves short-term outcomes in elective colectomy, however, the choice of surgical approach in hemodynamically stable patients with obstructing right-sided colon cancer remains unclear in emergency settings. MIS could be considered and the present study aims to evaluate short-term outcomes of MIS in bowel obstructed patients compared with open surgery (OPEN).

Methods
A retrospective nationwide study including patients from the nationwide Swedish Colorectal Cancer Registry (SCRCR) undergoing emergency right-sided colectomy in Sweden (2017–2023) was conducted. Propensity score matching (1:1) was performed based on sex, age, ASA class, hospital size, and operative timing (on-call vs. daytime). Outcomes included length of stay (LOS), postoperative complications, and surgical quality indicators. Analysis was performed according to intention-to-treat.

Results
A total of 1147 patients were identified. Of the 1,147 included patients, 99 (8.6%) underwent an initially minimally invasive approach. After matching, 99 patients remained in each group. The conversion rate was 34%.

Median LOS was 9 days (IQR 6;14) after OPEN and 6 days (IQR 5;10) after MIS. In quantile regression with bootstrap standard errors, MIS was associated with a 3-day shorter median LOS (median difference − 3.0 days, 95% CI − 4 to − 2, p = 0.002).

Postoperative complications (Clavien-Dindo ≥ 2) occurred in 38.8% after OPEN and in 23.2% after MIS. Logistic regression analysis with robust standard errors showed significantly lower odds of postoperative complications after MIS (OR 0.48, 95% CI 0.27–0.83, p = 0.009).

No significant differences were observed in re-admission, 90-day mortality, R0 resection, lymph node yield, blood loss or operative time.

Conclusion
In this nationwide observational cohort, an initially minimally invasive approach was associated with shorter length of stay and fewer postoperative complications. No statistically significant differences were observed in the available short-term surgical and pathological quality indicators. Given the limited number of MIS procedures and potential for residual confounding, these findings support further evaluation of MIS in carefully selected patients. (Less)
Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
World Journal of Emergency Surgery
volume
21
article number
54
pages
1 - 11
publisher
BioMed Central (BMC)
ISSN
1749-7922
DOI
10.1186/s13017-026-00735-6
language
English
LU publication?
yes
id
79dc6d3b-d895-4600-a10a-a565939029ff
date added to LUP
2026-10-06 13:35:35
date last changed
2026-10-06 14:17:26
@article{79dc6d3b-d895-4600-a10a-a565939029ff,
  abstract     = {{Abstract<br/>Background<br/>Minimally invasive surgery (MIS) improves short-term outcomes in elective colectomy, however, the choice of surgical approach in hemodynamically stable patients with obstructing right-sided colon cancer remains unclear in emergency settings. MIS could be considered and the present study aims to evaluate short-term outcomes of MIS in bowel obstructed patients compared with open surgery (OPEN).<br/><br/>Methods<br/>A retrospective nationwide study including patients from the nationwide Swedish Colorectal Cancer Registry (SCRCR) undergoing emergency right-sided colectomy in Sweden (2017–2023) was conducted. Propensity score matching (1:1) was performed based on sex, age, ASA class, hospital size, and operative timing (on-call vs. daytime). Outcomes included length of stay (LOS), postoperative complications, and surgical quality indicators. Analysis was performed according to intention-to-treat.<br/><br/>Results<br/>A total of 1147 patients were identified. Of the 1,147 included patients, 99 (8.6%) underwent an initially minimally invasive approach. After matching, 99 patients remained in each group. The conversion rate was 34%.<br/><br/>Median LOS was 9 days (IQR 6;14) after OPEN and 6 days (IQR 5;10) after MIS. In quantile regression with bootstrap standard errors, MIS was associated with a 3-day shorter median LOS (median difference − 3.0 days, 95% CI − 4 to − 2, p = 0.002).<br/><br/>Postoperative complications (Clavien-Dindo ≥ 2) occurred in 38.8% after OPEN and in 23.2% after MIS. Logistic regression analysis with robust standard errors showed significantly lower odds of postoperative complications after MIS (OR 0.48, 95% CI 0.27–0.83, p = 0.009).<br/><br/>No significant differences were observed in re-admission, 90-day mortality, R0 resection, lymph node yield, blood loss or operative time.<br/><br/>Conclusion<br/>In this nationwide observational cohort, an initially minimally invasive approach was associated with shorter length of stay and fewer postoperative complications. No statistically significant differences were observed in the available short-term surgical and pathological quality indicators. Given the limited number of MIS procedures and potential for residual confounding, these findings support further evaluation of MIS in carefully selected patients.}},
  author       = {{Agger, Erik and Matthiessen, Peter and Vedin, Tomas}},
  issn         = {{1749-7922}},
  language     = {{eng}},
  month        = {{10}},
  pages        = {{1--11}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{World Journal of Emergency Surgery}},
  title        = {{Minimally invasive versus open emergency right-sided colectomy for malignant obstruction: a nationwide propensity score–matched cohort study}},
  url          = {{http://dx.doi.org/10.1186/s13017-026-00735-6}},
  doi          = {{10.1186/s13017-026-00735-6}},
  volume       = {{21}},
  year         = {{2026}},
}