TTP1.08 Laparoscopic vs open: factors associated with operative approach and long-term outcomes in right-sided hemicolectomy patients

Introduction The impact of surgical approach (laparoscopic vs. open) on the peri-operative outcome following right hemicolectomy is debated. The aim of this study was to examine factors associated with laparoscopic versus open approach and the impact of operative approach on outcome for patients undergoing right hemicolectomy in NHS Tayside. Method An prospective observational cohort study of patients undergoing both emergency and elective right-sided hemicolectomy between 2010-2020 was conducted. Each patient had subsequently follow up for complications and survival. Univariate and multivariate analysis was performed (logistic regression and cox proportional hazards model). Results A total of 1206 patients were included (M:F 0.8:1, median age, 71; 929 malignant cases; 277 benign cases). Variables positively associated with open approach were emergency operation (OR = 13.3, p<0.0001), benign pathology (OR= 1.77, p=0.052) and increasing BMI (OR= 1.03, p=0.068). Open conversion was positively associated with readmission within 30 days (OR= 1.68, p=0.031) but not associated with anastomotic leak (OR 1.05; p=0.82) or patient mortality (OR=0.88, p=0.75). Using the log rank test, open surgery was positively associated with earlier death (p<0.001) but this wasn’t supported in multivariate analysis (HR=0.96, p=0.825). Discussion Open Hemicolectomy may increase the rates of short-term readmission but there are no clear differences in anastomotic leak or long-term survival outcomes between operative approach.