Laparoscopic surgery improves postoperative outcomes in high-risk patients with colorectal cancer
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and Other Interventional Techniques
Laparoscopic surgery improves postoperative outcomes in high-risk patients with colorectal cancer Francesco Feroci • Maddalena Baraghini • Elisa Lenzi • Alessia Garzi • Andrea Vannucchi Stefano Cantafio • Marco Scatizzi
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Received: 18 March 2012 / Accepted: 21 August 2012 / Published online: 6 October 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Background Patients with significant comorbidities often are denied laparoscopic colorectal resections, because they are thought to be too ‘‘high-risk.’’ This study was designed to examine the feasibility and safety of laparoscopic colorectal resections in high-risk colorectal cancer patients and to compare them with a similar cohort of patients undergoing open resections in the same time period. Methods This was a single-center, prospective, cohort study conducted at a high-volume, nonuniversity, tertiary care hospital. From a database of 616 patients submitted to elective colorectal surgery for cancer within a fast-track protocol (January 2005 to November 2011), 188 patients who met at least one minor (age [80 years and body mass index (BMI) [30 m/kg2) and one major (cardiac, pulmonary, renal or liver disease, diabetes mellitus) criterion were classified as high-risk. Differences in baseline characteristics, intraoperative outcomes, and short-term (30-day) postoperative outcomes, as well as the pathology findings and the readmission and reoperation rates, were compared between the open and laparoscopic cohorts in both high- and low-risk groups and between high- and lowrisk groups. Results During the study period, 68 high-risk patients underwent laparoscopic resections and 120 had open surgeries. A shorter length of postoperative stay (6 vs. 9 days, p \ 0.0001) and fewer postoperative nonsurgical complications (4 % vs. 19 %, p = 0.003) were observed among the laparoscopic group. Postoperative major (p = 0.774)
F. Feroci (&) M. Baraghini E. Lenzi A. Garzi A. Vannucchi S. Cantafio M. Scatizzi Department of General Surgery, Misericordia e Dolce Hospital, Piazza dell’Ospedale 5, 59100 Prato, PO, Italy e-mail: [email protected]
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and minor complications (p = 0.3) and reoperations (p = 0.196) were similar between the two groups, and a significantly lower rate of mortality (1.5 vs. 7.5 %, p = 0.038) was observed in the laparoscopic group than in the open group. Conclusions Laparoscopic colorectal resection can be safely performed on ‘‘high-risk’’ surgical patients with better results than a similar group of high-risk patients undergoing open colon resections. Keywords Laparoscopic colorectal surgery High-risk patients Colorectal cancer
The feasibility of laparoscopic colectomy procedures, in terms of both safety and oncological radicality, has been reported since 1991 with data from several randomized trials [1–5]. These trials demonstrated that improvements in short-term postoperative results could be achieved without compromising long-term oncological results. The percentage of elective colectomies performe
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