학술논문
Laparoscopy may decrease morbidity and length of stay after elective colon cancer resection, especially in frail patients: results from an observational real-life study
Document Type
Original Paper
Author
Cerdán Santacruz, Carlos; Frasson, Matteo; Flor-Lorente, Blas; Ramos Rodríguez, José Luis; Trallero Anoro, Marta; Millán Scheiding, Mónica; Maseda Díaz, Olga; Dujovne Lindenbaum, Paula; Monzón Abad, Andrés; García-Granero Ximenez, Eduardo; Alvarez Rico, Miguel Angel; García Brao, Maria Jesus; Sanchez Gonzalez, Juan Manuel; Braithwaite, Mariela; Martí Martínez, Eva; Álvarez Pérez, José Antonio; Espí, Alejandro; Romero Simó, Manuel; Escoll Rufino, Jordi; Santamaría Olabarrieta, Marta; Viñas Martínez, José; López Bañeres, Manolo; Blesa Sierra, Isabel; Feliú Villaró, Francesc; Aguiló Lucía, Javier; Bargallo Berzosa, José; Alonso Hernández, Natalia; Labrador Vallverdú, Francisco Javier; Parra Baños, Pedro Antonio; Ais Conde, Guillermo; Codina Cazador, Antonio; Hernandis Villalba, Juan; Álvarez Laso, Carlos; Martínez Alcaide, Sonia; Cáceres Alvarado, María Nieves; Rey Simó, Ignacio; Montero García, Josep; García Fadrique, Alfonso; Aguilella Diago, Vicente; García Septiem, Javier; García García, Jacinto; Ponchietti, Luca; Carceller Navarro, María Soledad; Ramos Fernández, María; Conde Muiño, Raquel; Huerga Álvarez, Daniel; Menéndez Sánchez, Pablo; Maristany Bienert, Carlos; García Martínez, María Teresa; Moreno Muzas, Celia; Pastor Idoate, Carlos; Andicoechea, Alejandro; Alonso Casado, Adolfo Pedro; Roig Vila, José Vicente; Goded Broto, Ignacio; Collera, Pablo; Arroyo Sebastián, Antonio; The ANACO Study Group
Source
Surgical Endoscopy: And Other Interventional TechniquesOfficial Journal of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and European Association for Endoscopic Surgery (EAES). :1-11
Subject
Language
English
ISSN
0930-2794
1432-2218
1432-2218
Abstract
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.