James E Tooley1, Lindsay A Sceats2, Daniel D Bohl3, Blake Read4, Cindy Kin5. 1. Department of Medicine, Stanford University School of Medicine, Stanford, California. 2. Department of Surgery, Stanford University School of Medicine, Stanford, California. 3. Department of Orthopedic Surgery, Rush University School of Medicine, Chicago, Illinois. 4. Department of Colon and Rectal Surgery, Mount Sinai School of Medicine, New York, New York. 5. Department of Surgery, Stanford University School of Medicine, Stanford, California. Electronic address: cindykin@stanford.edu.
Abstract
BACKGROUND: Abdominoperineal resection (APR) is primarily used for rectal cancer and is associated with a high rate of complications. Though the majority of APRs are performed as open procedures, laparoscopic APRs have become more popular. The differences in short-term complications between open and laparoscopic APR are poorly characterized. METHODS: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to determine the frequency and timing of onset of 30-d postoperative complications after APR and identify differences between open and laparoscopic APR. RESULTS: A total of 7681 patients undergoing laparoscopic or open APR between 2011 and 2015 were identified. The total complication rate for APR was high (45.4%). APRs were commonly complicated by blood transfusion (20.1%), surgical site infection (19.3%), and readmission (12.3%). Laparoscopic APR was associated with a 14% lower total complication rate compared to open APR (36.0% versus 50.1%, P < 0.001). This was primarily driven by a decreased rate of transfusion (10.7% versus 24.9%, P < 0.001) and surgical site infection (15.5% versus 21.2%, P < 0.001). Laparoscopic APR had shorter length of stay and decreased reoperation rate but similar rates of readmission and death. Cardiopulmonary complications occurred earlier in the postoperative period after APR, whereas infectious complications occurred later. CONCLUSIONS: Short-term complications following APR are common and occur more frequently in patients who undergo open APR. This, along with factors such as risk of positive pathologic margins, surgeon skill set, and patient characteristics, should contribute to the decision-making process when planning rectal cancer surgery.
BACKGROUND: Abdominoperineal resection (APR) is primarily used for rectal cancer and is associated with a high rate of complications. Though the majority of APRs are performed as open procedures, laparoscopic APRs have become more popular. The differences in short-term complications between open and laparoscopic APR are poorly characterized. METHODS: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to determine the frequency and timing of onset of 30-d postoperative complications after APR and identify differences between open and laparoscopic APR. RESULTS: A total of 7681 patients undergoing laparoscopic or open APR between 2011 and 2015 were identified. The total complication rate for APR was high (45.4%). APRs were commonly complicated by blood transfusion (20.1%), surgical site infection (19.3%), and readmission (12.3%). Laparoscopic APR was associated with a 14% lower total complication rate compared to open APR (36.0% versus 50.1%, P < 0.001). This was primarily driven by a decreased rate of transfusion (10.7% versus 24.9%, P < 0.001) and surgical site infection (15.5% versus 21.2%, P < 0.001). Laparoscopic APR had shorter length of stay and decreased reoperation rate but similar rates of readmission and death. Cardiopulmonary complications occurred earlier in the postoperative period after APR, whereas infectious complications occurred later. CONCLUSIONS: Short-term complications following APR are common and occur more frequently in patients who undergo open APR. This, along with factors such as risk of positive pathologic margins, surgeon skill set, and patient characteristics, should contribute to the decision-making process when planning rectal cancer surgery.
Authors: Marley Ribeiro Feitosa; Lucas Fernandes de Freitas; Antonio Balestrim Filho; Guilherme Seizem Nakiri; Daniel Giansante Abud; Ligia Magnani Landell; Mariângela Ottoboni Brunaldi; Jose Joaquim Ribeiro da Rocha; Omar Feres; Rogério Serafim Parra Journal: World J Clin Oncol Date: 2020-12-24
Authors: Esther Jutten; Schelto Kruijff; Anne Brecht Francken; Martijn F Lutke Holzik; Barbara L van Leeuwen; Henderik L van Westreenen; Kevin P Wevers Journal: BJS Open Date: 2021-11-09