BACKGROUND: Due to safety concerns, the use of laparoscopy in high-risk colorectal surgery patients has been limited. Small reports have demonstrated the benefit of laparoscopy in this population; however, large comparative studies are lacking. STUDY DESIGN: A retrospective review of the Nationwide Inpatient Sample 2009 was conducted. Patients undergoing elective colorectal resections for benign and malignant pathology were included in the high-risk group if they had at least two of the following criteria: age > 70, obesity, smoking, anemia, congestive heart failure, valvular disease, diabetes mellitus, chronic pulmonary, kidney and liver disease. Using multivariate logistic regression, the outcomes of laparoscopic surgery were compared to open and converted surgery. RESULTS: Of 145,600 colorectal surgery cases, 32.79% were high-risk. High-risk patients had higher mortality, hospital charges, and longer hospital stay compared to low-risk patients. The use of laparoscopy was lower in the high-risk group with higher conversion rates. In high-risk patients, compared to open surgery, laparoscopy was associated with lower mortality (OR = 0.60), shorter hospital stay, lower charges, decreased respiratory failure (OR = 0.53), urinary tract infection (OR = 0.64), anastomotic leak (OR = 0.69) and wound complications (OR = 0.46). Conversion to open surgery was not associated with higher mortality. CONCLUSIONS: Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.
BACKGROUND: Due to safety concerns, the use of laparoscopy in high-risk colorectal surgery patients has been limited. Small reports have demonstrated the benefit of laparoscopy in this population; however, large comparative studies are lacking. STUDY DESIGN: A retrospective review of the Nationwide Inpatient Sample 2009 was conducted. Patients undergoing elective colorectal resections for benign and malignant pathology were included in the high-risk group if they had at least two of the following criteria: age > 70, obesity, smoking, anemia, congestive heart failure, valvular disease, diabetes mellitus, chronic pulmonary, kidney and liver disease. Using multivariate logistic regression, the outcomes of laparoscopic surgery were compared to open and converted surgery. RESULTS: Of 145,600 colorectal surgery cases, 32.79% were high-risk. High-risk patients had higher mortality, hospital charges, and longer hospital stay compared to low-risk patients. The use of laparoscopy was lower in the high-risk group with higher conversion rates. In high-risk patients, compared to open surgery, laparoscopy was associated with lower mortality (OR = 0.60), shorter hospital stay, lower charges, decreased respiratory failure (OR = 0.53), urinary tract infection (OR = 0.64), anastomotic leak (OR = 0.69) and wound complications (OR = 0.46). Conversion to open surgery was not associated with higher mortality. CONCLUSIONS: Laparoscopy in high-risk colorectal patients is safe and may demonstrate advantages compared to open surgery.
Authors: Celia N Robinson; Courtney J Balentine; Christy L Marshall; Jonathan A Wilks; Daniel Anaya; Avo Artinyan; David H Berger; Daniel Albo Journal: J Surg Res Date: 2010-12-10 Impact factor: 2.192
Authors: Ruben Veldkamp; Esther Kuhry; Wim C J Hop; J Jeekel; G Kazemier; H Jaap Bonjer; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio M Lacy Journal: Lancet Oncol Date: 2005-07 Impact factor: 41.316
Authors: Amy J Sheer; Jennifer E Heckman; Eric B Schneider; Albert W Wu; Jodi B Segal; Richard Feinberg; Anne O Lidor Journal: Dis Colon Rectum Date: 2011-11 Impact factor: 4.585
Authors: I Arteaga González; E M López-Tomassetti Fernández; Y Hernández Piñero; A Martín Malagón; J Arranz Durán; S Bethencourt Muñoz; H Díaz; A Carrillo Journal: Int J Colorectal Dis Date: 2007-10-05 Impact factor: 2.571
Authors: Zhobin Moghadamyeghaneh; Steven D Mills; Alessio Pigazzi; Joseph C Carmichael; Michael J Stamos Journal: J Gastrointest Surg Date: 2014-05-20 Impact factor: 3.452
Authors: Wissam J Halabi; Mehraneh D Jafari; Joseph C Carmichael; Vinh Q Nguyen; Steven Mills; Michael Phelan; Michael J Stamos; Alessio Pigazzi Journal: Surg Endosc Date: 2013-07-09 Impact factor: 4.584