PURPOSE
The aim of this study was to evaluate whether laparoscopic colorectal surgery can modify the risk factors for the occurrence of postoperative morbidity.
METHODS
A total of 384 consecutive patients with colorectal disease were randomized to laparoscopic resection (n = 190) or open resection (n = 194). On admission, demographics, comorbidity, and nutritional status were recorded. Operative variables, patient outcome, and length of stay were also recorded. Postoperative complications were registered by four members of staff not involved in the study.
RESULTS
The overall morbidity rate was 27.1 percent, with the rate in the laparoscopic group (18.7 percent) being less than that in the open group (31.5 percent; P = 0.003). Patients who underwent laparoscopic resection had a faster recovery of bowel function (P = 0.0001) and a shorter length of stay (P = 0.0001). In the whole cohort of patients, multivariate analysis identified open surgery (P = 0.003), duration of surgery (P = 0.01), and homologous blood transfusion (P = 0.01) as risk factors for postoperative morbidity. In the open group, blood loss (P = 0.01), homologous blood transfusion (P = 0.01), duration of surgery (P = 0.009), weight loss (P = 0.06), and age (P = 0.08) were related to postoperative morbidity. In the laparoscopic group the only risk factor identified was duration of surgery (P = 0.005).
CONCLUSION
In the laparoscopic group, both postoperative morbidity and length of stay were significantly reduced and most risk factors for postoperative morbidity disappeared.
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REFERENCES
JW Milsom B Bohm KA Hammerhoffer VW Fazio E Steiger P Elson (1998) ArticleTitleA prospective randomized trial comparing laparoscopic vs conventional techniques in colorectal cancer surgery: a preliminary report J Am Coll Surg 187 46–57 Occurrence Handle10.1016/S1072-7515(98)00132-X Occurrence Handle1:STN:280:DyaK1czitFClsw%3D%3D Occurrence Handle9660024
J Psaila SH Bulley P Ewings JP Sheffield RH Kennedy (1998) ArticleTitleOutcome following laparoscopic resection for colorectal cancer Br J Surg 85 662–4 Occurrence Handle10.1046/j.1365-2168.1998.00634.x Occurrence Handle1:STN:280:DyaK1c3pslOnsg%3D%3D Occurrence Handle9635817
M Braga A Vignali W Zuliani et al. (2002) ArticleTitleMetabolic and functional results after laparoscopic colorectal surgery: a randomized controlled trial Dis Colon Rectum 45 1070–77 Occurrence Handle10.1007/s10350-004-6362-2 Occurrence Handle12195192
L Stocchi H Nelson TM Young Fadok DR Larson DM Ilstrup (2000) ArticleTitleSafety and advantages of laparoscopic vs open colectomy in the elderly: matched-control study Dis Colon Rectum 43 326–32 Occurrence Handle1:STN:280:DC%2BD3c7psFamsw%3D%3D Occurrence Handle10733113
CL Tang KW Eu BC Tai JGS Soh D Machin F Seow Choen (2001) ArticleTitleRandomized clinical trial on the effect of open vs laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer Br J Surg 88 801–7 Occurrence Handle10.1046/j.1365-2168.2001.01653.x Occurrence Handle11412248
AM Lacy S Delgado JC Garcia-Valdecasas et al. (1998) ArticleTitlePort site metastases and recurrence after laparoscopic colectomy: a randomized trial Surg Endosc 12 1039–42 Occurrence Handle10.1007/s004649900776 Occurrence Handle1:STN:280:DyaK1czls1eksA%3D%3D Occurrence Handle9685538
AM Lacy JC Garcia-Valdecasas S Delgado et al. (2002) ArticleTitleLaparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial Lancet 359 2224–9 Occurrence Handle10.1016/S0140-6736(02)09290-5 Occurrence Handle12103285
JW Milsom KA Hammerhofer B Bohm P Marcello P Elson VW Fazio (2001) ArticleTitleProspective, randomized trial comparing laparoscopic vs conventional surgery for refractory ileocolic Crohn’s disease Dis Colon Rectum 44 1–9 Occurrence Handle1:STN:280:DC%2BD38%2FnvVGjtg%3D%3D Occurrence Handle11805557
JT Liang MJ Shieh CN Chen YM Cheng KY Chang SM Wang (2002) ArticleTitleProspective evaluation of laparoscopy-assisted colectomy versus laparotomy with resection for management of complex polyps of the sigmoid colon World J Surg 26 377–83 Occurrence Handle10.1007/s00268-001-0235-9 Occurrence Handle11865378
M Braga A Vignali L Gianotti et al. (2002) ArticleTitleLaparoscopic versus open colorectal surgery: a randomized trial on short-term outcome Ann Surg 236 759–67 Occurrence Handle10.1097/00000658-200212000-00008 Occurrence Handle12454514
K Nishiguchi J Okuda M Toyoda K Tanaka N Tanigawa (2001) ArticleTitleComparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma Dis Colon Rectum 44 223–30 Occurrence Handle1:STN:280:DC%2BD3M7ot1Sksw%3D%3D Occurrence Handle11227939
KL Leung PB Lai RL Ho et al. (2000) ArticleTitleSystemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial Ann Surg 231 506–11 Occurrence Handle10.1097/00000658-200004000-00008 Occurrence Handle1:STN:280:DC%2BD3c3htlaitg%3D%3D Occurrence Handle10749610
W Schwenk C Jacobi U Mausmann et al. (2000) ArticleTitleInflammatory response after laparoscopic and conventional colorectal resections. Results of a prospective randomized trial Langenbecks Arch Surg 385 2–9 Occurrence Handle10.1007/s004230050002 Occurrence Handle1:STN:280:DC%2BD3c7jtFSluw%3D%3D Occurrence Handle10664112
JW Milsom BL Bohm (1996) Laparoscopic colorectal surgery Springer-Verlag New York
F Bozzetti M Braga L Gianotti et al. (2001) ArticleTitlePostoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial Lancet 358 1487–92 Occurrence Handle10.1016/S0140-6736(01)06578-3 Occurrence Handle1:STN:280:DC%2BD3MnltFKqsg%3D%3D Occurrence Handle11705560
JC Weeks H Nelson S Gerber D Sargent G Schroeder (2002) ArticleTitleShort-term quality of life outcomes following laparoscopic assisted colectomy versus open colectomy for colon cancer JAMA 287 321–8 Occurrence Handle10.1001/jama.287.3.321 Occurrence Handle11790211
M Braga A Vignali W Zuliani et al. (2002) ArticleTitleTraining period in laparoscopic colorectal surgery. A case matched comparative study with open surgery Surg Endosc 16 31–5 Occurrence Handle10.1007/s00464-001-9035-4 Occurrence Handle1:STN:280:DC%2BD383isFGnsQ%3D%3D Occurrence Handle11961600
WA See CS Cooper RJ Fisher (1993) ArticleTitlePredictors of laparoscopic complications after formal training in laparoscopic surgery JAMA 270 2689–92 Occurrence Handle10.1001/jama.270.22.2689 Occurrence Handle1:STN:280:ByuC1c%2Fks1U%3D Occurrence Handle8133586
F Kockerling J Rose C Schneider et al. (1999) ArticleTitleLaparoscopic colorectal anastomosis: risk of postoperative leakage Surg Endosc 13 639–44 Occurrence Handle10.1007/s004649901064 Occurrence Handle1:STN:280:DyaK1Mzhs1erug%3D%3D Occurrence Handle10384066
CM Schlachta J Mamazza PA Seshadri M Cadeddu EC Poulin (2000) ArticleTitleDeterminants of outcome in laparoscopic colorectal surgery Surg Endosc 14 258–63 Occurrence Handle10.1007/s004640000050 Occurrence Handle1:STN:280:DC%2BD3c3gtlCruw%3D%3D Occurrence Handle10741445
D Hong J Tabet M Anvari (2001) ArticleTitleLaparoscopic vs. open resection for colorectal adenocarcinoma Dis Colon Rectum 44 10–9 Occurrence Handle1:STN:280:DC%2BD38%2FnvVGjtw%3D%3D Occurrence Handle11805558
EL Bokey JW Moore PH Chapuis RC Newland (1996) ArticleTitleMorbidity and mortality following laparoscopic-assisted right hemicolectomy for cancer Dis Colon Rectum 39 (Suppl) S24–8
GA Fielding J Lumley L Nathanson P Hewitt M Rhodes R Stitz (1997) ArticleTitleLaparoscopic colectomy Surg Endosc 11 745–9 Occurrence Handle10.1007/s004649900441 Occurrence Handle1:STN:280:ByiA283jsVY%3D Occurrence Handle9214324
F Kockerling C Schneider MA Reymond (1998) ArticleTitleEarly results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery Surg Endosc 12 37–41 Occurrence Handle10.1007/s004649900588 Occurrence Handle1:STN:280:DyaK1c%2Fos1yhsQ%3D%3D Occurrence Handle9419300
P Reissman S Cohen EG Weiss SD Wexner (1996) ArticleTitleLaparoscopic colorectal surgery: ascending the learning curve Word J Surg 20 227–81
L Bardram P Funch-Jensen H Kehlet (2000) ArticleTitleRapid rehabilitation in elderly patients after laparoscopic colonic resection Br J Surg 87 1540–5 Occurrence Handle10.1046/j.1365-2168.2000.01559.x Occurrence Handle1:STN:280:DC%2BD3M%2FltFOhsw%3D%3D Occurrence Handle11091243
PI Tartter S Quintero DM Barron (1986) ArticleTitlePerioperative blood transfusion associated with infectious complications after colorectal cancer operations Am J Surg 152 479–82 Occurrence Handle10.1016/0002-9610(86)90207-2 Occurrence Handle1:STN:280:BiiD2cnmtVE%3D Occurrence Handle3777324
A Vignali M Braga P Dionigi et al. (1995) ArticleTitleImpact of a programme of autologous blood transfusion on the incidence of infection in patients with colorectal cancer Eur J Surg 161 487–92 Occurrence Handle1:STN:280:BymD38npsFM%3D Occurrence Handle7488662
A Vignali M Braga L Gianotti et al. (1996) ArticleTitleA single unit of transfused allogenic blood increases postoperative infections Vox Sang 71 170–7 Occurrence Handle10.1046/j.1423-0410.1996.7130170.x Occurrence Handle1:STN:280:ByiD28bjt1I%3D Occurrence Handle8912460
G Pawelec M Adibzadeh R Solana I Beckman (1997) ArticleTitleThe T cell in the ageing individual Mech Ageing Dev 93 35–45 Occurrence Handle10.1016/S0047-6374(96)01812-X Occurrence Handle1:CAS:528:DyaK2sXitFGqtLc%3D Occurrence Handle9089569
N Blumberg JM Heal (1989) ArticleTitleTransfusion and recipient immune function Arch Pathol Lab Med 113 245–6
GD Harmon AJ Senagore MJ Kilbride MJ Warzynski (1994) ArticleTitleInterleukin-6 response to laparoscopic and open colectomy Dis Colon Rectum 37 754–9 Occurrence Handle1:STN:280:ByuA3szgslc%3D Occurrence Handle8055718
HP Redmond RW Watson T Houghton C Condron RG Watson D Bouchier–Hayes (1994) ArticleTitleImmune function in patients undergoing open vs laparoscopic cholecystectomy Arch Surg 129 1240–6 Occurrence Handle1:STN:280:ByqD2sjkvVI%3D Occurrence Handle7986152
FJ Vittimberga DP Foley WC Meyers MP Callery (1988) ArticleTitleLaparoscopic surgery and the systemic immune response Ann Surg 227 326–34 Occurrence Handle10.1097/00000658-199803000-00003
FP Wu C Sietses BM Blomberg Particlevon PA Leeuwen Particlevan S Meijer MA Cuesta (2003) ArticleTitleSystemic and peritoneal inflammatory response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial Dis Colon Rectum 46 147–55
PM Hewitt SM Ip SP Kwok et al. (1998) ArticleTitleLaparoscopic–assisted vs. open surgery for colorectal cancer: comparative study of immune effects Dis Colon Rectum 41 901–9 Occurrence Handle1:STN:280:DyaK1czktFGiug%3D%3D Occurrence Handle9678378
AJ Senagore CP Delaney HJ Duepree KM Brady VW Fazio (2003) ArticleTitleEvaluation of POSSUM and P-POSSUM scoring system in assessing outcome after laparoscopic colectomy Br J Surg 90 1280–4 Occurrence Handle10.1002/bjs.4224 Occurrence Handle1:STN:280:DC%2BD3svltl2gsg%3D%3D Occurrence Handle14515300
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Vignali, A., Braga, M., Zuliani, W. et al. Laparoscopic Colorectal Surgery Modifies Risk Factors for Postoperative Morbidity. Dis Colon Rectum 47, 1686–1693 (2004). https://doi.org/10.1007/s10350-004-0653-5
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DOI: https://doi.org/10.1007/s10350-004-0653-5