Colonoscopy Assisted Laparoscopic Wedge Resection for Colonic Lesions: Impact on Quality of LifE: Results from the LIMERIC Study

Abstract

BACKGROUND: The LIMERIC study has proven that colonoscopy-assisted laparoscopic wedge resection effectively and safely removes benign colonic lesions unsuitable for endoscopic removal, thereby avoiding the need for major surgery. OBJECTIVE: To evaluate the impact of colonoscopy-assisted laparoscopic wedge on health-related quality of life of patients who participated in the LIMERIC study. DESIGN: Prospective multicenter study. SETTINGS: The LIMERIC study was performed between 2016 and 2020 in 13 Dutch hospitals. Five-level EuroQoL 5-dimension questionnaires were administered at baseline and 3 months after the procedure. PATIENTS: Patients with incomplete pre- or postoperative questionnaires or those undergoing combined interventions were excluded from the intention-to-treat analysis. Those for whom CAL-WR was not feasible or who underwent completion surgery were excluded from the per-protocol analysis. INTERVENTION: Colonoscopy-assisted laparoscopic wedge for either 1) colon polyp unsuitable for endoscopic resection; 2) nonlifting residual or recurrent polyp within scar tissue after previous polypectomy; or (3) Rx/R1 endoscopic removal of a low-risk pT1 colon carcinoma. MAIN OUTCOME MEASURES: Three-month health-related quality of life. RESULTS: Colonoscopy-assisted laparoscopic wedge did not affect health-related quality of life in the per-protocol analysis (n = 56) or in the intention-to-treat analysis (n = 67). The majority of patients reported no change in health status (57%). No significant differences were observed in the distribution of responses across all 5 dimensions before and after colonoscopy-assisted laparoscopic wedge. Patients’EuroQoL self-rated visual analog scale scores were also unaffected by a colonoscopy-assisted laparoscopic wedge, with a median score of 82.5 at baseline and 80 after surgery in the per-protocol analysis (p = 0.63). LIMITATIONS: Solely a patient-reported outcome measure evaluating global health-related quality of life was used, rather than one specifically assessing disease-related quality of life, such as the quality of life questionnaire colorectal cancer module 29. CONCLUSIONS: Colonoscopy-assisted laparoscopic wedge has no significant impact on the health-related quality of life in patients with benign colonic lesions and should therefore be considered before major surgery is performed.