@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}},
}