Safety Of Laparoscopic Colorectal Resection Research Articles

P-183 Laparoscopic colorectal resection for elderly patients aged 80 years or older: A propensity score analysis

Some randomized clinical trials showed the positive results of laparoscopic approach mainly for non-elderly patients with colorectal cancer (CRC), but for elderly patients, it remains unclear. The aim of this study was to evaluate the feasibility and safety of laparoscopic colorectal resection for elderly patients.

Safety of Laparoscopic Colorectal Resection in Patients With Severe Comorbidities.

We aimed to assess the safety of laparoscopic colorectal resection in patients with severe comorbidities. High operative risk was defined as an American Society of Anesthesiologists (ASA) class 3 score. Outcomes in 34 patients with an ASA score of 3 undergoing laparoscopic surgery (LAP3) were compared with 172 laparoscopic surgery patients with an ASA score ≤2 (LAP2) and 32 laparotomy patients with an ASA score of 3 (OP3). The postoperative complication rate in LAP3 was similar to that seen in LAP2 and significantly lower than that seen in OP3 (LAP2, 4.0%; LAP3, 5.9%; OP3, 31.2%). The incidence of postoperative hemorrhage, infection, ileus, and anastomotic leakage was similar between LAP3 and LAP2 and between LAP3 and OP3. However, the systemic complication rate in LAP3 was similar to that seen in LAP2 and significantly lower than that seen in OP3. Laparoscopic colorectal resection can be performed safely in patients with severe comorbidities.

Laparoscopic colorectal resection versus open colorectal resection in octogenarians: a systematic review and meta-analysis of safety and efficacy

Octogenarians are more often viewed as high-risk surgical candidates. This increased risk is attributed to an age-related decline in physical function and reserve capacity coupled with the presence of various underlying diseases. There are no current guidelines or consensus on the optimal treatment strategy for this cohort of complex patients. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of laparoscopic colorectal resection versus open colorectal resection in octogenarians. The meta-analysis was conducted following all aspects of the Cochrane Handbook for Systematic Reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic literature review was carried out using the following databases: MEDLINE, Embase, PubMed, the Cochrane Library, Google Scholar and OVID. Only studies comparing outcome of laparoscopic and open colorectal resections in the elderly population (≥80 years) were selected. The data collected included the patient demographics, interventions, observed outcome and sources of bias. When performing the statistical analysis, we used the odds ratio for categorical variables and the weighted mean difference for continuous variables. The results of this systematic review and pooled analysis demonstrated the safety and potential benefits of laparoscopic colorectal resection in octogenarians. LC can reduce the length of hospital stay, intraoperative blood loss, time to return of normal bowel function, and incidence of postoperative pneumonia, wound infection, and postoperative ileus.

Synchronous resections of primary colorectal tumor and liver metastasis by laparoscopic approach

Liver metastasis of colorectal cancer is common. Resection of solitary tumors of primary and metastatic colorectal cancer can have a favorable outcome. Open resection of primary colorectal tumor and liver metastasis in one operation or in separate operations is currently common practice. Reports have shown that synchronous resections do not jeopardize short or long-term surgical outcomes and that this is a safe and effective approach in open surgery. The development of laparoscopic colorectal surgery and laparoscopic hepatectomy has made a minimally invasive surgical approach to treating colorectal cancer with liver metastasis feasible. Synchronous resections of primary colorectal tumor and liver metastasis by laparoscopy have recently been reported. The efficacy and safety of laparoscopic colorectal resection and laparoscopic hepatectomy have been proven separately but synchronous resections by laparoscopy are in hot debate. As it has been shown that open resection of primary colorectal tumor and liver metastasis in one operation results in an equally good short-term outcome when compared with that done in separate operations, laparoscopic resection of the same in one single operation seems to be a good option. Recent evidence has shown that this new approach is a safe alternative with a shorter hospital stay. Large scale randomized controlled trials are needed to demonstrate the effectiveness of this minimally invasive approach.

Analysis of Laparoscopic Colorectal Surgery in High-risk Patients

The aim of this retrospective study is to examine the feasibility and safety of laparoscopic colorectal resection for colorectal malignancies to determine "high-risk" patients. In our classification, 3 minor criteria including patients over 70 years of age, body mass index over 30 m/kg, and cigarette smoking and 5 major criteria including cardiac, pulmonary, renal, liver disease, and diabetes mellitus were selected to determine a high-risk group. Patients carrying 1 minor and 1 major criteria were classified as the high-risk group. Concerning patients and operations, hemodynamic values (mean arterial systolic and diastolic pressures and heart rates), oxygen saturations, end-expiratory carbon dioxide levels, respiratory mechanics (dynamic compliance, peak inspiratory pressure, airway resistance) were analyzed. Cardiovascular system (myocardial infarction, arrhythmia, hypertension), pulmonary system (respiratory insufficiency), digestive system (anastomotic leak, fistula, and paralytic ileus), fever, thrombophlebitis, urinary infections, wound infections, and central nervous system (delirium and cerebrovascular accident) were also investigated. A total number of 85 high-risk patients were included in the study. Gastrointestinal leaks in 2.3%, fistula in 1.1%, ileus in 3.5%, postoperative bleeding in 2.3%, postoperative fever in 5.8%, wound infection in 5.8%, and cerebrovascular accidents in 1.1% of patients were detected. The lowest values of hemodynamic and respiratory mechanics were observed at the induction of pneumoperitoneum and in this period the compliance and mean arterial pressure were determined to be 36+/-14 mm Hg and 84+/-14 mm Hg, respectively. No mortalities occurred. In experienced hands, laparoscopic colorectal resection can be performed safely for "high-risk" surgical patients.

Redefining contraindications to laparoscopic colorectal resection for high-risk patients

Patients with major comorbidities often are denied laparoscopic colorectal resections because they are thought to be at too "high risk." Paradoxically, these patients generally have the most to gain from a minimally invasive surgical approach. This study aimed to examine the feasibility and safety of laparoscopic colorectal resection to determine whether it is contraindicated for "high-risk" patients. From August 1996 to February 2004, 368 consecutive patients (95 men) undergoing a laparoscopic colorectal procedure by a single surgeon were prospectively studied with regard to pre-, peri-, and postoperative events. High-risk patients (n = 190) were defined as elderly (age, >80 years; n = 28), morbidly obese (body mass index [BMI], >30 kg/m(2); n = 55), American Society of Anesthesiology (ASA) 3 or 4 (n = 130), and recipients of preoperative radiotherapy (n = 54). Multiple risk factors were found for 67 patients, 7 of whom had three risk factors. The median age of the patients was 66 years (range, 19-92 years). The diagnoses included rectal cancer (n = 48), diverticulitis (n = 43), colon cancer (n = 34), benign polyp (n = 26), and other (n = 39). The following procedures were performed: colon resection (n = 114; left, 63; right, 41; total abdominal colectomy, 10), rectal resection (low anterior resection or pouch) (n = 49), coloanal anastomosis (n = 23), and other (n = 4). Data regarding intent to treat, operative events, morbidity, mortality, and outcomes were analyzed and form the basis of this report. No mortalities occurred. The major morbidity rate was 2%. There were no anastomotic leaks. The cases were laparoscopically performed (94%) or laparoscopically assisted, or were converted to open procedure (3%). The median estimated blood loss was 200 ml, and only 5% required perioperative transfusion. The perioperative course involved the following median periods: 2 days until flatus, 3 days until bowel movement, 1 day until clear liquid diet, 3 days until a regular diet, and 5 days until hospital discharge. In experienced hands, laparoscopic colorectal resection can be performed safely for "high-risk" surgical patients. The better than expected outcomes in this patient population reinforce the benefits of minimally invasive surgery for this patient group and argues against using parameters of increased age, morbid obesity, high ASA class, or preoperative radiation alone as contraindications to even complex laparoscopic colorectal procedures.