Guend Hamza, Lee David Y, Myers Elizabeth A, Gandhi Nipa D, Cekic Vesna, Whelan Richard L
Division of Colon and Rectal Surgery, Department of Surgery, Mt Sinai St Luke's/Mt Sinai Roosevelt Hospital Center, 1000 10th Ave, Suite 2B, New York, NY, 10019, USA,
Surg Endosc. 2015 Sep;29(9):2763-9. doi: 10.1007/s00464-014-4007-7. Epub 2014 Dec 6.
The utilization rates for minimally invasive colorectal resection techniques (MICR) continue to increase. In some centers MICR methods are the preferred approach, however, open methods continue to be utilized for select patients. In this study, the profile and short-term outcomes of open colorectal resection (CR) and MICR patients are determined and compared.
A retrospective review of patients who underwent elective CR over 11 years at two institutions was performed. The MICR group contained both laparoscopic-assisted and hand-assisted cases. The past medical and surgical histories, indications, operations performed, and short-term outcomes were assessed. The Charlson co-morbidity index (CMI) was used to assess risk.
During the study period 1080 patients underwent CR (Open, 141; MICR, 939). As judged by the CMI, there were more high-risk patients (score ≥2) in the Open group (34.38%) versus MICR (22.11%) p = 0.0029. Significantly more open patients had prior abdominal surgery and specifically CRs (Open, 15.60% vs. MICR, 2.13%, p < 0.001). Intraoperative transfusion (Open 25.7%; MICR 6.8%, p < 0.001) and diversion (25.53 vs. 11.50%, p < 0.001) were more common in the Open group. Not surprisingly, recovery of bowel function and length of stay were longer for the Open group. The overall complication rate was also higher for the Open patients (p < 0.001).
When MICR is the procedure of choice, patients selected for Open CR are higher risk and more complex as judged by the CMI and past operative history. Not surprisingly, this translates into a longer length of stay, higher rates of transfusion, diversion, and complications. This disparity in patients undergoing CRs makes direct comparison of MICR and Open resection outcomes not reasonable.
微创结直肠切除技术（MICR）的使用率持续上升。在一些中心，MICR方法是首选方法，然而，对于特定患者仍继续采用开放手术方法。在本研究中，确定并比较了开放性结直肠切除术（CR）和MICR患者的概况及短期预后。
对两家机构11年间接受择期CR的患者进行回顾性研究。MICR组包括腹腔镜辅助和手辅助病例。评估既往病史和手术史、适应症、所实施的手术及短期预后。采用Charlson合并症指数（CMI）评估风险。
在研究期间，1080例患者接受了CR（开放手术141例；MICR 939例）。根据CMI判断，开放手术组的高危患者（评分≥2）比例（34.38%）高于MICR组（22.11%），p = 0.0029。开放手术患者既往腹部手术尤其是CR的比例显著更高（开放手术组15.60% vs. MICR组2.13%，p < 0.001）。开放手术组术中输血（开放手术组25.7%；MICR组6.8%，p < 0.001）和改道（25.53% vs. 11.50%，p < 0.001）更为常见。不出所料，开放手术组肠道功能恢复和住院时间更长。开放手术患者总体并发症发生率也更高（p < 0.001）。
当选择MICR时，根据CMI和既往手术史判断，选择开放CR的患者风险更高且情况更复杂。不出所料，这导致住院时间更长、输血率、改道率和并发症发生率更高。CR患者的这种差异使得直接比较MICR和开放切除术的结果不合理。
