Table 1.

Summary of the studies on minimally invasive colectomy in emergent or urgent settings

Authors, year	Study design	Sample size (n)	Study population	Surgical techniques	Conversion rate (LC to OC)	Main findings	Conclusion of the study
Ng et al., 2008 [19]	Case–control study	43	All patients presented with obstructing right colon carcinoma	The study compared 14 LC vs. 29 OC	Nil (0/14)	LC had longer operative time (187.5 min vs. 145 min), less blood loss, earlier ambulation compared to OC. No group difference was found for time to return of gastrointestinal function, duration of hospital stay (4 days for LC vs. 6 days for OC), and post-operative morbidity (28.6% for LC vs. 55.2% for OC). Overall mortality was nil.	Emergency LC for obstructing right-sided colonic carcinoma is feasible and safe.
Champagne et al., 2009 [18]	Case series	20	18 patients were operated for non-malignant diseases and 2 patients for colon carcinoma	All patients were operated by LC	10% (2/20): 1 for diverticulitis, 1 for left sided colon carcinoma	The mean operative time was 162 min and the average length of hospital stay was 8 days. There was 1 reoperation and 3 readmissions within 30 days, with no mortality during the follow-up. Six patients required ICU stays after surgery, and 40% of the patients had one or more postoperative complications.	LC is a feasible option in emergency situations once the surgeon has overcome the learning curve in elective LC procedures.
Stulberg et al., 2009 [20]	Case–control study	65	55 patients operated for non-malignant diseases, and 10 for colon carcinoma (3 by OC and 7 by LC).	The study compared 40 LC vs. 25 OC	10% (4/40)	The mean operative time was 180 min for OC and 159 min for LC. LC was associated with lower blood and shorter postoperative stay (8 days for LC vs. 11 days for OC). Perioperative mortality rates were similar between groups (1 for LC vs. 3 for OC).	LC is a feasible option in certain emergency situations.
Catani et al., 2011 [17]	Matched case–control study	93	81 patients were operated for non-malignant diseases and 12 patients for colon cancer	The study compared 32 LC vs. 61 OC	5.8% (2/32): 2 cases of perforated diverticulitis	No group difference for mortality (0 for LC and 1 for OC) and the mean operative time (189 min for LC vs. 180 min for OC). LC showed lower post-operative morbidity (0% for LC vs. 14.7% for OC) and shorter hospital stay (6 days for LC vs. 8 days for OC).	With increasing experience, LC would be a feasible and an effective option in emergency settings lowering complication rate and length of hospital stay.
Ballian et al., 2012 [22]	Propensity Score-matched case–control study	3552	26.6% of patients in the LC group and 14.4% in the OC group were operated for colon or rectum carcinoma. The remaining for different non-malignant diseases.	The study compared 341 LC vs. 3211 OC	Not reported	LC was associated with longer operative time (142 min vs. 122 min) and shorter hospital stay (11.2 days vs. 15 days) compared to OC. The need for intraoperative blood transfusion, the postoperative morbidity, the 30-day reoperation rates, and the mortality were comparable between groups.	LC with primary anastomosis performed in emergency setting has postoperative morbidity and mortality rates comparable to those seen with OC. LC is associated with longer operative time but reduces the postoperative length of hospital stay.
Koh et al., 2013 [12]	Matched case–control study	46	36 patients were operated for non-malignant disease and 10 patients for colon carcinoma (4 by OC and 6 LC)	The study compared 23 LC (15 of which were LHC) vs. 23 OC	17.4% (4/23)	LC was associated with longer operative time (175 min for LC vs. 145 min for OC). The duration of hospitalization (6 days for LC vs. 7 days for OC) and the postoperative morbidity rates were similar between groups. Three patients in each group required postoperative ICU stays or reoperations. Overall mortality was nil. The LC did not incur a higher cost.	Emergency LC in a carefully selected patient group is safe. Although the operative times were longer, the postoperative outcomes were comparable to those of the OC.
Odermatt et al., 2013 [21]	Propensity Score-matched case–control study	108	All patients presented with colonic or rectosigmoid junction cancer	The study compared 36 LC vs. 72 OC	8% (3/36) 2 cases of advanced T4 cancers needing extensive resection; 1 case of cancer of transverse colon operated by a general surgeon lacking experience in laparoscopy	LC was associated with a greater number of lymph nodes harvested (17 vs. 13) and a shorter hospital stay (7.5 vs. 11.0 days) compared to OC. The overall 3-year survival rate was 51% in the LC group and 43% in the OC group; the 3-year recurrence-free survival rate was 35% in the LC group and 37% in the OC group, without group difference.	Selective emergency LC for colon cancer performed by experienced specialist colorectal surgeons is not inferior to open surgery with regard to short- and long-term outcomes. LC resulted in a shorter length of hospital stay.

LC stands for laparoscopic colectomy; LHC for laparoscopic hand-assisted colectomy; OC for open colectomy; ICU for intensive care unit.