Schlussel Andrew T, Lustik Michael B, Johnson Eric K, Maykel Justin A, Champagne Brad J, Goldberg Joel E, Steele Scott R
1 Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii 2 Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii 3 Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington 4 Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 5 Division of Colorectal Surgery, Department of Surgery, University Hospitals-Case Medical Center, Cleveland, Ohio 6 Section of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Dis Colon Rectum. 2015 Apr;58(4):431-43. doi: 10.1097/DCR.0000000000000325.
Since the introduction of laparoscopic colectomy, experience and technology continue to improve. Although accepted for many colorectal conditions, its use and outcomes in complex procedures are less understood.
The purpose of this work was to compare the perioperative outcomes of laparoscopic transverse colectomy and total abdominal colectomy (study group) with an open approach (comparative group) and the more established laparoscopic right, left, and sigmoid colectomies (control group).
This was a retrospective review of the Nationwide Inpatient Sample (2008-2011) of all patients undergoing elective right, left, sigmoid, total, or transverse colectomy as identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. Risk-adjusted 30-day outcomes were assessed using regression modeling accounting for patient characteristics, comorbidities, and surgical procedures.
The study included a national sample from a population database.
There were 45,771 admissions: 2946 in the study group, 36,949 in the control group, and 5876 in the open comparative group.
Mortality was the primary outcome. Secondary outcomes included in-hospital complications, length of stay, and hospital charges.
The patients were predominantly white (73%), had private insurance (64%), and underwent surgery at urban centers (92%). Mortality was similar between the study and control groups (0.42% vs 0.51%; p = 0.52), with a higher complication rate in the study group (19% vs 14%; p < 0.01). The study group was also associated with a lower mortality rate compared with the open group (0.51% vs 2.20%; p < 0.01), which remained consistent after adjusting for covariates (OR, 0.38 [95% CI, 0.20-0.71]; p < 0.01). The study group had fewer complications overall compared with the open group (19% vs 27%; p < 0.01) and a shorter median length of stay (4.6 vs 6.3 days; p < 0.01).
This was a retrospective study using an administrative database.
A laparoscopic approach for total abdominal and transverse colectomies has similar mortality rates and slightly higher complications than the more established laparoscopic colectomy procedures and improved perioperative outcomes when compared with an open technique (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A178).
自腹腔镜结肠切除术引入以来，经验和技术不断改进。尽管它已被应用于多种结直肠疾病，但在复杂手术中的应用及结果仍鲜为人知。
本研究旨在比较腹腔镜横结肠切除术和全腹结肠切除术（研究组）与开放手术（比较组）以及更成熟的腹腔镜右半结肠、左半结肠和乙状结肠切除术（对照组）的围手术期结果。
这是一项对全国住院患者样本（2008 - 2011年）的回顾性研究，所有患者均接受了择期右半结肠、左半结肠、乙状结肠、全结肠或横结肠切除术，通过国际疾病分类第九版临床修订版手术编码进行识别。使用回归模型评估风险调整后的30天结果，该模型考虑了患者特征、合并症和手术方式。
该研究纳入了来自人口数据库的全国样本。
共有45771例入院患者：研究组2946例，对照组36949例，开放比较组5876例。
死亡率是主要结局。次要结局包括住院期间并发症、住院时间和住院费用。
患者主要为白人（73%），有私人保险（64%），且在城市中心接受手术（92%）。研究组和对照组的死亡率相似（0.42%对0.51%；p = 0.52），研究组的并发症发生率更高（19%对14%；p < 0.01）。与开放组相比，研究组的死亡率也更低（0.51%对2.20%；p < 0.01），在调整协变量后仍保持一致（OR，0.38 [95% CI，0.20 - 0.71]；p < 0.01）。与开放组相比，研究组总体并发症更少（19%对27%；p < 0.01），中位住院时间更短（4.6天对6.3天；p < 0.01）。
这是一项使用行政数据库的回顾性研究。
与开放技术相比，腹腔镜全腹和横结肠切除术的死亡率相似，并发症略高于更成熟的腹腔镜结肠切除术，且围手术期结果有所改善（见视频，补充数字内容1，http://links.lww.com/DCR/A178）。
