Bilimoria Karl Y, Bentrem David J, Merkow Ryan P, Nelson Heidi, Wang Edward, Ko Clifford Y, Soper Nathaniel J
Department of Surgery, Feinberg School of Medicine, Northwestern University, 251 E. Huron Street, Galter 3-150, Chicago, IL 60611, USA.
J Gastrointest Surg. 2008 Nov;12(11):2001-9. doi: 10.1007/s11605-008-0568-x. Epub 2008 Jun 24.
Overall postoperative morbidity and mortality after laparoscopic-assisted colectomy (LAC) and open colectomy (OC) have been shown to be generally comparable; however, differences in the occurrence of specific complications are unknown. The objective of this study was to determine whether certain complications occurred more frequently after LAC vs. OC for colon cancer.
Using the American College of Surgeons-National Surgical Quality Improvement Project's (ACS-NSQIP) participant-use file, patients were identified who underwent colectomy for cancer at 121 participating hospitals in 2005-2006. Multiple logistic regression models including propensity scores were developed to assess the risk-adjusted association between surgical approach (LAC vs. OC) and 30-day outcomes. Patients were excluded if they underwent emergent procedures, were ASA class 5, or had metastatic disease.
Of the 3,059 patients who underwent elective colectomy for cancer, 837 (27.4%) underwent LAC and 2,222 (72.6%) underwent OC. There were no significant differences in age, comorbidities, ASA class, or body mass index (BMI) between patients undergoing LAC vs. OC. Patients undergoing LAC had a lower likelihood of developing any adverse event compared to OC (14.6% vs. 21.7%; OR 0.64, 95% CI 0.51-0.81, P < 0.0001), specifically surgical site infections, urinary tract infections, and pneumonias. Mean length of stay was significantly shorter after LAC vs. OC (6.2 vs. 8.7 days, P < 0.0001). There were no differences between LAC and OC in the reoperation rate (5.5% vs. 5.8%, P = 0.79) or 30-day mortality (1.4% vs. 1.8%, P = 0.53).
Laparoscopic-assisted colectomy was associated with lower morbidity compared to OC in select patients, specifically for infectious complications.
腹腔镜辅助结肠切除术（LAC）和开放结肠切除术（OC）术后的总体发病率和死亡率已显示总体相当；然而，特定并发症发生情况的差异尚不清楚。本研究的目的是确定结肠癌患者接受LAC与OC后某些并发症的发生频率是否更高。
利用美国外科医师学会-国家外科质量改进项目（ACS-NSQIP）的参与者使用文件，确定了2005 - 2006年在121家参与医院接受结肠癌结肠切除术的患者。建立了包括倾向评分的多个逻辑回归模型，以评估手术方式（LAC与OC）与30天结局之间的风险调整关联。如果患者接受急诊手术、美国麻醉医师协会（ASA）分级为5级或患有转移性疾病，则将其排除。
在3059例接受择期结肠癌结肠切除术的患者中，837例（27.4%）接受了LAC，2222例（72.6%）接受了OC。接受LAC与OC的患者在年龄、合并症、ASA分级或体重指数（BMI）方面无显著差异。与OC相比，接受LAC的患者发生任何不良事件的可能性更低（14.6%对21.7%；比值比0.64，95%置信区间0.51 - 0.81，P < 0.0001），特别是手术部位感染、尿路感染和肺炎。LAC后的平均住院时间明显短于OC（6.2天对8.7天，P < 0.0001）。LAC与OC在再次手术率（5.5%对5.8%，P = 0.79）或30天死亡率（1.4%对1.8%，P = 0.53）方面无差异。
在特定患者中，腹腔镜辅助结肠切除术与OC相比，发病率较低，特别是对于感染性并发症。
