OBJECTIVE: To investigate the safety of laparoscopic colorectal cancer resections in a nationwide population-based study. BACKGROUND: Although laparoscopic techniques are increasingly used in colorectal cancer surgery, little is known on results outside trials. With the fast introduction of laparoscopic resection (LR), questions were raised about safety. METHODS: Of all patients who underwent an elective colorectal cancer resection in 2010 in the Netherlands, 93% were included in the Dutch Surgical Colorectal Audit. Short-term outcome after LR, open resection (OR), and converted LR were compared in a generalized linear mixed model. We further explored hospital differences in LR and conversion rates. RESULTS: A total of 7350 patients, treated in 90 hospitals, were included. LR rate was 41% with a conversion rate of 15%. After adjustment for differences in case-mix, LR was associated with a lower risk of mortality (odds ratio 0.63, P < 0.01), major morbidity (odds ratio 0.72, P < 0.01), any complications (odds ratio 0.74, P < 0.01), hospital stay more than 14 days (odds ratio 0.71, P < 0.01), and irradical resections (odds ratio 0.68, P < 0.01), compared to OR. Outcome after conversion was similar to OR (P > 0.05). A large variation in LR and conversion rates among hospitals was found; however, the difference in outcome associated with operative techniques was not influenced by hospital of treatment. CONCLUSIONS: Use of laparoscopic techniques in colorectal cancer surgery in the Netherlands is safe and results are better in short-term outcome than open surgery, irrespective of the hospital of treatment. Outcome after conversion was similar to OR.

Objective: The aim of the study was to identify risk factors for postoperative mortality in patients undergoing surgery for colon cancer. We looked specifically at patients ≥ 80 years of age in whom a nonelective colon cancer resection was performed. Study Design: Observational study. Methods: We included data from 6,161 patients who underwent colon cancer surgery in 2010 in a Dutch hospital; a nonelective colon cancer resection was performed in 1,172 of these patients. Risk factors for postoperative mortality were identified using a multivariate logistic regression analysis. We studied elective and nonelective intestinal resections separately in different age groups. Results: Mortality in the total study population was 4.9%. Mortality increased with age in patients who underwent either elective or nonelective intestinal resection. For patients ≥ 80 years of age who underwent nonelective intestinal resection, each additional risk factor doubled the mortality risk. In patients aged ≥ 80 years with an American Society of Anesthesiologists classification of class ≥ 3 who underwent a left hemicolectomy or 'other' intestinal resection, the postoperative mortality rate was 41%; in patients of the same age without additional risk factors this was 7%. CONCLUSIONS In patients ≥ 80 years of age with 2 or more additional risk factors, nonelective intestinal resection should be considered a high-risk procedure with a mortality risk of up to 41%. This result can be used in clinical decision making concerning treatment and in providing information for patients and their families.