Andrew T Schlussel1, Michael B Lustik2, Eric K Johnson3, Justin A Maykel4, Brad J Champagne5, Joel E Goldberg6, Scott R Steele7. 1. Department of Surgery, Tripler Army Medical Center, Honolulu, HI, USA. 2. Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI, USA. 3. Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA. 4. Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA. 5. Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, OH, USA. 6. Section of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 7. Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA, USA. Electronic address: harkersteele@mac.com.
Abstract
BACKGROUND: Although minimally invasive colorectal surgery increases widely, outcomes following its use in complex operations such as the abdominoperineal resection (APR) remain indeterminate. METHODS: A review of the Nationwide Inpatient Sample (2008 to 2011) of all patients undergoing elective laparoscopic or open APR was conducted. Risk-adjusted 30-day outcomes were assessed using regression modeling accounting for patient characteristics, comorbidities, and surgical procedure. RESULTS: We identified 3,191 admissions meeting inclusion criteria (1,019 laparoscopic; 2,172 open). The conversion rate was 5%. Mortality was low and similar between groups (.88% vs .83%, P = .91). In-hospital complication rates were lower in the laparoscopic group (19% vs 29%, odds ratio .59, 95% confidence interval .49 to .71, P < .01), but conversion was associated with a higher rate (29% vs 18%, P < .01). Finally, a laparoscopic APR was associated with a shorter length of stay (5.3 vs 7.0 days, P < .01). CONCLUSION: Laparoscopic APR is associated with improved outcomes and may be the preferred approach by surgeons with appropriate skills and experience. Published by Elsevier Inc.
BACKGROUND: Although minimally invasive colorectal surgery increases widely, outcomes following its use in complex operations such as the abdominoperineal resection (APR) remain indeterminate. METHODS: A review of the Nationwide Inpatient Sample (2008 to 2011) of all patients undergoing elective laparoscopic or open APR was conducted. Risk-adjusted 30-day outcomes were assessed using regression modeling accounting for patient characteristics, comorbidities, and surgical procedure. RESULTS: We identified 3,191 admissions meeting inclusion criteria (1,019 laparoscopic; 2,172 open). The conversion rate was 5%. Mortality was low and similar between groups (.88% vs .83%, P = .91). In-hospital complication rates were lower in the laparoscopic group (19% vs 29%, odds ratio .59, 95% confidence interval .49 to .71, P < .01), but conversion was associated with a higher rate (29% vs 18%, P < .01). Finally, a laparoscopic APR was associated with a shorter length of stay (5.3 vs 7.0 days, P < .01). CONCLUSION: Laparoscopic APR is associated with improved outcomes and may be the preferred approach by surgeons with appropriate skills and experience. Published by Elsevier Inc.
Entities:
Keywords:
Abdominoperineal resection; Laparoscopy; Population database; Postoperative complications; Proctectomy
Authors: Gabriela Batista Rodríguez; Andrea Balla; Santiago Corradetti; Carmen Martinez; Pilar Hernández; Jesús Bollo; Eduard M Targarona Journal: Int J Colorectal Dis Date: 2018-04-06 Impact factor: 2.571