Gastrointestinal Recovery After Laparoscopic Partial Large Bowel Resection: Results of a Prospective, Observational, Multicenter Study

Introduction: A prospective, multicenter, observational study (14CL401) investigated gastrointestinal (GI) recovery, length of hospital stay (LOS), and postoperative ileus (POI)-related morbidity after laparoscopic bowel resection (LBR). Methods: Adult patients undergoing LBR with primary anastomosis performed by straight (SL) or hand-assisted (HAL) laparoscopy with scheduled postoperative intravenous patient-controlled analgesia were enrolled. The study design was similar to alvimopan phase III open laparotomy BR studies, including the use of a standardized accelerated care pathway; in this study, >80% of sites participated in one or more phase III open BR trials. Primary endpoints were GI-2 recovery (first bowel movement and tolerating solid food) and postoperative LOS (hospital discharge day minus day of surgery). Secondary endpoints included POI-related morbidity (postoperative nasogastric tube insertion and investigator-assessed POI resulting in prolonged hospital stay or readmission), conversion-to-open (CTO) rate, and protocol-defined prolonged POI (GI-2 >5 postoperative days [POD]). Results: Of 148 patients enrolled (mean, 58.3 years old), 67 patients received a right partial colectomy by SL, 42 received a left partial colectomy by SL, and 39 received a left partial colectomy by HAL. The CTO rate was 18.8%, with approach-specific CTO rates of 25.4% (SL left), 17.3% (HAL left), and 15.0% (SL right). Mean time to GI-2 recovery was 4.4 days and mean postoperative LOS was 4.9 days (range, 2-41 days), neither of which varied substantially by surgical approach. Prolonged POI (GI-2 >5 POD) occurred in 15 (10.1%) patients and overall POI-related morbidity occurred in 17 (11.5%) patients; 7 (4.7%) patients had nasogastric tube insertion and 15 (10.1%) patients had prolonged stay because of investigator-assessed POI. No patients were readmitted because of POI whereas 3 (2%) patients were readmitted for all causes (excluding POI). Conclusions: Mean GI recovery and LOS after LBR were 0.7 and 1.7 days earlier, respectively, versus the pooled open placebo BR population in the phase III alvimopan POI trials. Overall POI-related morbidity, however, was similar across the LBR and open BR populations. In conclusion, while the use of laparoscopic technique with a standardized accelerated care pathway resulted in marginally earlier GI recovery and a slightly decreased LOS compared with the pooled open placebo BR population in the phase III alvimopan POI studies, POI continues to present an important morbidity regardless of surgical approach.

Session: Podium Presentation

Program Number: S046

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