Laparoscopy may decrease morbidity and length of stay after elective colon cancer resection, especially in frail patients: results from an observational real-life study.

Autor: Cerdán Santacruz C; Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain. carloscerdansantacruz@hotmail.com., Frasson M; Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain., Flor-Lorente B; Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain., Ramos Rodríguez JL; Department of General Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain., Trallero Anoro M; Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain., Millán Scheiding M; Hospital Universitario Bellvitge, Barcelona, Spain., Maseda Díaz O; Hospital Universitario Lucus Augusti, Lugo, Spain., Dujovne Lindenbaum P; Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain., Monzón Abad A; Hospital Universitario Miguel Servet, Saragossa, Spain., García-Granero Ximenez E; Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2017 Dec; Vol. 31 (12), pp. 5032-5042. Date of Electronic Publication: 2017 Apr 28.
DOI: 10.1007/s00464-017-5548-3
Abstrakt: Background: Advantages of laparoscopic approach in colon cancer surgery have been previously demonstrated in controlled, randomized trials and in retrospective analysis of large administrative databases. Nevertheless, evidence of these advantages in prospective, observational studies from real-life settings is scarce.
Methods: This is a prospective, observational study, including a consecutive series of patients that underwent elective colonic resection for cancer in 52 Spanish hospitals. Pre-/intraoperative data, related to patient, tumor, surgical procedure, and hospital, were recorded as well as 60-day post-operative outcomes, including wound infection, complications, anastomotic leak, length of stay, and mortality. A univariate and multivariate analysis was performed to determine the influence of laparoscopy on short-term post-operative outcome. A sub-analysis of the effect of laparoscopy according to patients' pre-operative risk (ASA Score I-II vs. III-IV) was also performed.
Results: 2968 patients were included: 44.2% were initially operated by laparoscopy, with a 13.9% conversion rate to laparotomy. At univariate analysis, laparoscopy was associated with a decreased mortality (p = 0.015), morbidity (p < 0.0001), wound infection (p < 0.0001), and post-operative length of stay (p < 0.0001). At multivariate analysis, laparoscopy resulted as an independent protective factor for morbidity (OR 0.7; p = 0.004), wound infection (OR 0.6; p < 0.0001), and length of post-operative stay (Effect-2 days; p < 0.0001), compared to open approach. These advantages were more relevant in high-risk patients (ASA III-IV), even if the majority of them were operated by open approach (67.1%).
Conclusions: In a real-life setting, laparoscopy decreases wound infection rate, post-operative complications, and length of stay, especially in ASA III-IV patients.
Databáze: MEDLINE
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