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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s11605-012-2096-y | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Complex cesarean section: Surgical approach to reduce the risks of intraoperative complications and postpartum hemorrhage.
Int J Gynaecol Obstet
January 2025
FIGO, London, UK.
The incidence of cesarean section is dramatically increasing worldwide, whereas the training opportunities for obstetrician/gynecologists to manage complex cesarean section appear to be decreasing. This may be attributed to changing working hours directives and the increasing use of laparoscopy for gynecological surgical procedures, including in gynecological oncology. Various situations can create surgical difficulties during a cesarean section; however, two of the most frequent are complications from previous cesarean (myometrial defects, with or without placental intrusion and peritoneal adhesions) and the high risk of postpartum hemorrhage (uterine overdistension, abnormal placentation, uterine fibroids).
View Article and Find Full Text PDFShort- and long-term outcomes of vaginal, laparoscopic, and robotic-assisted surgery in "oldest old" endometrial cancer.
Eur J Surg Oncol
December 2024
Department of Obstetrics and Gynecology, 'Filippo Del Ponte' Hospital, University of Insubria, Varese, Italy.
Objective: To assess the safety and long-term effectiveness of minimally invasive approach in managing "oldest old" endometrial cancer patients.
Methods: This is a retrospective cohort, multi-institutional study. Consecutive patients, treated between 2000 and 2020, with apparent early-stage endometrial cancer patients, aged ≥85 years.
Outcomes of Laparoscopic Radical Hysterectomy in Ia1-Ib1 Cervical Cancer Patients: A Multi-Center Study with 10 Years' Experiences in the Real World.
Ann Surg Oncol
December 2024
Department of Gynecologic Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine Central, South University/Hunan Cancer Hospital, Changsha, People's Republic of China.
Article Synopsis
- The study assessed laparoscopic radical hysterectomy (LRH) outcomes in early-stage, low-risk cervical cancer patients compared to open abdominal radical hysterectomy (OARH).
- In low-risk cases, 5-year overall and progression-free survival rates were similar for LRH (98.6% OS, 97.6% PFS) and OARH (99.3% OS, 98.4% PFS), with no significant differences found.
- Conversely, in high-risk patients, LRH showed lower survival rates compared to OARH, indicating the need for careful surgical approach selection based on risk factors and imaging prior to surgery.
ArtiSential-assisted laparoscopic central pancreatectomy.
J Minim Invasive Surg
December 2024
Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Central pancreatectomy (CP) is a viable option for low malignant tumors located in the neck or proximal body of the pancreas. This procedure has the advantage of minimizing impairment to pancreatic function. However, it is technically challenging and carries a relatively high risk of postoperative pancreatic fistula.
View Article and Find Full Text PDFWhich is the best timing for performing a cholecystectomy after percutaneous cholecystostomy?
Surg Endosc
January 2025
Hospital Universitario Mayor - Méderi, Calle 24 #29 - 45, Bogotá, Colombia.
Article Synopsis
- Laparoscopic cholecystectomy is the preferred method for treating acute cholecystitis, but percutaneous cholecystostomy is often used for high-risk surgical patients as a temporary solution or definitive treatment.
- A review of existing literature, particularly focusing on a study by Spaniolas et al., was conducted to determine the best timing for laparoscopic cholecystectomy after cholecystostomy, but findings were inconclusive due to variability in study thresholds and limitations in the Spaniolas study.
- The conclusion emphasizes that timing the laparoscopic procedure for when it is least technically challenging can help reduce complications and need for additional surgeries, although solid scientific backing is still lacking.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!