Tadashi Yoshida, MD, PhD, Shigenori Homma, MD, PhD, Yosuke Ohno, MD, PhD, Nobuki Ichikawa, MD, PhD, Hideki Kawamura, MD, PhD, Akinobu Taketomi, MD, PhD. Hokkaido University Grduate School of Medicine
Background/Aim: Laparoscopic colorectal surgery has been widely spread even if patients have past history of abdominal operation. However, widespread adhesion caused by past abdominal operation may result in increase of postoperative complications. We evaluated the impact of past abdominal operation in laparoscopic colorectal resection (LCR).
Methods: We performed elective LCR on 354 patients for primary colorectal cancers between June 2008 and June 2015. Seventy-two patients were excluded in this study following reasons: 44 patients underwent multiple organ resection, and colorectal cancer was diagnosed with Stage IV in 28 patients. Accordingly, 282 patients were eligible for comparative analysis, with 70 in group PO (post operation) and 212 in group C (control). In group PO, past operative procedures were as follows: appendectomy (57%), digestive tract (7%), hepato-billiary-pancreatic (7%), gynecologic (17%), urologic surgery (10%), and others (2%).
Results: There were no significant differences between two groups in ASA (grade ≤2: 81 vs. 88%, p=0.14), BMI (23.4 vs. 23.1 kg/m2, p=0.53), tumor location (right colon/ left colon/ rectum 47/19/34 vs. 33/30/37%, p=0.48), or Stage (≤1: 40 vs. 36%, p=0.53) except for age (Group PO vs. C: 70.4 vs. 66.7 y.o., p<0.01) and the ratio of male patients (49 vs. 67%, p<0.01). Peri- and postoperative factors were almost equivalent between two groups including operative procedure (right side colon/ left colon/ rectal resection 47/14/39 vs. 35/22/43%, p=0.15), the number of dissected lymph nodes (16.6 vs. 16.6, p=0.99), surgical time (173.9 vs. 183.7 min, p=0.18), estimated blood loss (32.4 vs. 26.6 gram, p=0.67), conversion to open surgery (1.4 vs. 1.9%, p=0.80), re-operation (4.3 vs. 1.4%, p=0.15), length of postoperative stay (14.6 vs. 13.0 days, p=0.41), and re-admission (2.9 vs. 1.4%, p=0.60). However, the incidence of postoperative complications (Clavien-Dindo classification grade ≥2) was significantly higher in group PO than in group C (24 vs. 11%, p<0.01), especially in surgical-site infections (9 vs. 3%, p=0.07). To evaluate the risk factors of postoperative complications, logistic regression analysis was performed. Univariate analysis showed four variables associated with the risk of postoperative complications: male (p=0.03), past operative history of digestive organs including appendectomy, digestive tract, and hepato-biliary-pancreatic surgery (p<0.001), conversion to open surgery (p=0.09), and estimated blood loss (p=0.03). Multivariate analysis showed that only past operative history of digestive organs was an independent factor associated with postoperative complications.
Conclusions: The incidence rate of postoperative complications in LCR was high in patients who had past history of abdominal operation, especially in digestive organs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87168
Program Number: P234
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster