Abstract
Background Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results Laparoscopic approach was associated with less intraoperative blood loss (MD = −174.03; 95% CI: −232.16 to −115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = −3.30; 95% CI: −3.75 to −2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.
Highlights
As with the advances in technology and the improvement in surgical techniques, laparoscopy has been widely applied in the field of gastrointestinal surgery
There seemed to be no significant difference in operating time between the two groups (MD = 17.71; 95% Confidence intervals open approach (OA) (CIs): −0.88 to 36.29, P = 0.06; P < 0.00001, I2=94% for heterogeneity) (Table 2)
A pooled analysis showed the length of hospital stay in the laparoscopic group was significantly shorter than that in the open group (MD = −3.30; 95% CI: −3.75 to −2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity) (Table 2)
Summary
As with the advances in technology and the improvement in surgical techniques, laparoscopy has been widely applied in the field of gastrointestinal surgery. Compared with open approach (OA), laparoscopic approach (LA) was reported to benefit patients who received major gastrointestinal surgery with less intraoperative blood loss, faster recovery, and shorter length of hospital stay [1,2,3,4,5] It remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD). Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay It remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits
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