Zettervall Sara L, Haskins Ivy N, Deery Sarah E, Amdur Richard L, Lin Paul P, Vaziri Khashayar
*Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC †Department of Surgery, Massachusetts General Hospital, Boston, MA.
Surg Laparosc Endosc Percutan Tech. 2017 Oct;27(5):361-365. doi: 10.1097/SLE.0000000000000443.
Laparoscopic colectomies are associated with reduced perioperative morbidity and mortality compared with open surgery. Nevertheless, many surgeons continue to utilize an open surgical approach due to the perceived benefits of shorter operative times. This study aims to compare the outcomes of laparoscopic versus open colectomies of equal or shorter operative duration.
All patients undergoing elective laparoscopic or open colectomy in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) were identified from the years 2005 through 2012. Patients were stratified first by operative procedure including partial colectomy, total colectomy, or low anterior resection. Each surgical group was then divided into 4 groups according to operative time: <90 minutes, ≥90 minutes and <3 hours, ≥3 hours and <6 hours, and ≥6 hours. In total, 30-day outcomes were compared between laparoscopic operations and open procedures of shorter or equivalent durations within each surgical group. Multivariate logistic regression was utilized to account for differences in patient demographics and comorbidities between the surgical groups.
In total, 156,503 patients met inclusion criteria; 112,053 (71.6%) patients underwent a partial colectomy, 13,838 (8.8%) patients underwent a total colectomy, and 30,612 (19.6%) patients underwent a low anterior resection. A laparoscopic approach was used in 34% (37,789 patients) of the partial colectomies performed, 31% (4285 patients) of the total colectomies performed, and 45% (13,850 patients) of the low anterior resections performed. For all procedures, laparoscopic operations <6 hours were associated with superior outcomes compared with shorter open procedures. The benefit of laparoscopic operations was lost when operative time exceeded 6 hours.
Laparoscopic colectomies are associated with improved outcomes compared with open operations that do not exceed an operative time of 6 hours. Given the potential to improve patient outcomes, consideration should be given to the laparoscopic approach for all colon surgeries expected to be completed in <6 hours.
与开腹手术相比，腹腔镜结肠切除术可降低围手术期发病率和死亡率。然而，由于认为开腹手术的手术时间较短，许多外科医生仍继续采用开腹手术方法。本研究旨在比较手术时间相同或更短的腹腔镜与开腹结肠切除术的结果。
从2005年至2012年在美国外科医师学会国家外科质量改进项目（ACS-NSQIP）中接受择期腹腔镜或开腹结肠切除术的所有患者中进行识别。患者首先按手术方式分层，包括部分结肠切除术、全结肠切除术或低位前切除术。然后根据手术时间将每个手术组分为4组：<90分钟、≥90分钟且<3小时、≥3小时且<6小时以及≥6小时。总共比较了每个手术组中腹腔镜手术与手术时间较短或相当的开腹手术的30天结果。采用多变量逻辑回归分析来解释手术组之间患者人口统计学和合并症的差异。
总共有156,503名患者符合纳入标准；112,053名（71.6%）患者接受了部分结肠切除术，13,838名（8.8%）患者接受了全结肠切除术，30,612名（19.6%）患者接受了低位前切除术。在进行的部分结肠切除术中，34%（37,789名患者）采用了腹腔镜手术方式，在进行的全结肠切除术中，31%（4285名患者）采用了腹腔镜手术方式，在进行的低位前切除术中，45%（13,850名患者）采用了腹腔镜手术方式。对于所有手术，与手术时间较短的开腹手术相比，手术时间<6小时的腹腔镜手术具有更好的结果。当手术时间超过6小时时，腹腔镜手术的优势丧失。
与手术时间不超过6小时的开腹手术相比，腹腔镜结肠切除术的结果更好。鉴于有可能改善患者预后，对于预计在<6小时内完成的所有结肠手术，应考虑采用腹腔镜手术方式。
