Vargas Gabriela M, Sieloff Eric P, Parmar Abhishek D, Tamirisa Nina P, Mehta Hemalkumar B, Riall Taylor S
Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA.
Department of Surgery, Louisiana State University Health-Shreveport, Shreveport, LA, USA.
Surg Endosc. 2016 May;30(5):1826-32. doi: 10.1007/s00464-015-4463-8. Epub 2015 Aug 19.
While there are many reported advantages to laparoscopic surgery compared to open surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery has not been studied. Our goal was to determine whether obese patients undergoing laparoscopic rectal surgery experienced the same benefits as non-obese patients.
We identified patients undergoing rectal resections using the National Surgical Quality Improvement Project Participant Use Data File. We performed multivariable analyses to determine the independent association between laparoscopy and postoperative complications.
A total of 26,437 patients underwent rectal resection. The mean age was 58.5 years, 32.6 % were obese, and 47.2 % had cancer. Laparoscopic procedures were slightly less common in obese patients compared to non-obese patients (36.0 vs. 38.2 %, p = 0.0006). In unadjusted analyses, complications were lower with the laparoscopic approach in both obese (18.9 vs. 32.4 %, p < 0.0001) and non-obese (15.6 vs. 25.3 %, p < 0.0001) patients. In a multivariable analysis controlling for potential confounders, the risk of postoperative complications increased as the degree of obesity worsened. The likelihood of experiencing a postoperative complication increased by 25, 45, and 75 % for obese class I, obese class II, and obese class III patients, respectively. A laparoscopic approach was associated with a 40 % decreased odds of a postoperative complication for all patients (OR 0.60, 95 % CI 0.56-0.64).
Laparoscopic rectal surgery is associated with fewer complications when compared to open rectal surgery in both obese and non-obese patients. Obesity was an independent risk factor for postoperative complications. In appropriately selected patients, rectal surgery outcomes may be improved with a minimally invasive approach.
虽然与开放手术相比，腹腔镜手术有许多已报道的优势，但腹腔镜手术方式对接受直肠手术的肥胖患者术后发病率的影响尚未得到研究。我们的目标是确定接受腹腔镜直肠手术的肥胖患者是否与非肥胖患者有相同的获益。
我们使用国家外科质量改进项目参与者使用数据文件识别接受直肠切除术的患者。我们进行多变量分析以确定腹腔镜检查与术后并发症之间的独立关联。
共有26437例患者接受了直肠切除术。平均年龄为58.5岁，32.6%为肥胖患者，47.2%患有癌症。与非肥胖患者相比，肥胖患者中腹腔镜手术的比例略低（36.0%对38.2%，p = 0.0006）。在未调整的分析中，肥胖患者（18.9%对32.4%，p < 0.0001）和非肥胖患者（15.6%对25.3%，p < 0.0001）中，腹腔镜手术方式的并发症发生率均较低。在控制潜在混杂因素的多变量分析中，术后并发症的风险随着肥胖程度的加重而增加。I级肥胖、II级肥胖和III级肥胖患者发生术后并发症的可能性分别增加25%、45%和75%。腹腔镜手术方式使所有患者术后并发症的几率降低40%（比值比0.60，95%置信区间0.56 - 0.64）。
与开放直肠手术相比，腹腔镜直肠手术在肥胖和非肥胖患者中均与较少的并发症相关。肥胖是术后并发症的独立危险因素。在适当选择的患者中，采用微创方法可能改善直肠手术的结果。
