Baongoc Nasri, MD1, Ken Yuu, MD2, Masanori Tada, PhD2, Naoto Nishi, MD3, Marius Calin, MD4. 1Bronx Lebanon Hospital, 2Tokyo Metropolitan Matsuzawa Hospital, 3Tohjun Hospital, 4Virtua Hospital
OBJECTIVES: To compare the short-term outcomes of laparoscopy versus open surgery in colorectal malignancies in patients with psychiatric comorbidity.
BACKGROUND: Many studies have associated the presence of psychiatric disorders to adverse outcomes. Although laparoscopic approach is minimally invasive, it is unclear whether laparoscopic colorectal resection is safe for patients with psychiatric comorbidity.
METHOD: A retrospective chart review of surgical patients with psychiatric comorbidity from April 2014 to April 2016 was conducted at the largest psychiatric center and middle volume hospital in Japan. Patients were divided into laparoscopy group (LG) (n=58) and open group (OG) (n=71). Pre-, intra- and post-operative data were recorded. Logistic and linear regression analysis was performed to delineate the predictors of complication and mortality. Statistical analysis was performed using SPSS programming version 23. A P value of 0.05 was used as statistically significant.
RESULTS: There were 42% (n=56) patients with schizophrenia, 30% (n=40) with dementia. The perioperative data set including gender, age, body mass index (BMI), ASA physical status, comorbidity, tumor size, histopathological result and pathological stage showed no difference between laparoscopy and open group. The conversion rate was 2.8%. Laparoscopy group had less blood loss (mean [SD], LG 88.05 [89.57] ml versus OG 325.80 [319.68] ml; (p=0.001), shorter time to oral intake (mean [SD], LG 2.47 [1.88] ml versus OG 3.69 [2.77] days; (p=0.003), less surgical site infection (SSI) (LG 6.7% versus OG 93.3%; p=0.002) and less small bowel obstruction (SBO) (LG 22.2% versus OG 77.8%; p=0.04). There was no difference in the length of stay, complications, and mortality between the two groups. After adjusting for age, BMI, ASA, operating time and blood loss, the open group was associated with an increased odds ratio for SSI (odds ratio OR=10.62) and SBO (odds ratio OR=1.83). Multiple linear regressions showed increased operating time in LG compared with OG.
CONCLUSIONS: Laparoscopic colorectal resection in colorectal cancer is associated with decreased risk of SSI and SBO compared to open procedure. After further study of patient selection criteria, we hypothesize that laparoscopic procedure is a preferred option for colorectal cancer in the increasing population with underlying psychiatric diseases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79341
Program Number: P649
Presentation Session: Poster (Non CME)
Presentation Type: Poster
