Park Soeun, Kang Jeonghyun, Park Eun Jung, Baik Seung Hyuk, Lee Kang Young
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Ann Coloproctol. 2017 Oct;33(5):184-191. doi: 10.3393/ac.2017.33.5.184. Epub 2017 Oct 31.
The impact of previous abdominal surgery (PAS) on surgical outcomes from laparoscopic and robot surgeries is inconclusive. This study aimed to investigate the impact of PAS on perioperative outcomes from laparoscopic and robotic colorectal surgeries.
From March 2007 to February 2014, a total of 612 and 238 patients underwent laparoscopic and robotic surgeries, respectively. Patients were divided into 3 groups: those who did not have a PAS (NPAS), those who had a major PAS, and those who had a minor PAS. We further divided the patients so that our final groups for analysis were: patients with NPAS (n = 478), major PAS (n = 19), and minor PAS (n = 115) in the laparoscopy group, and patients with NPAS (n = 202) and minor PAS (n = 36) in the robotic surgery group.
In the laparoscopy group, no differences in the conversion rates between the 3 groups were noted (NPAS = 1.0% vs. major PAS = 0% vs. minor PAS = 1.7%, P = 0.701). In the robotic surgery group, the conversion rate did not differ between the NPAS group and the minor PAS group (1.0% vs. 2.8%, P = 0.390). Among the groups, neither the operation time, blood loss, days to soft diet, length of hospital stay, nor complication rate were affected by PAS.
PAS did not jeopardize the perioperative outcomes for either laparoscopic or robotic colorectal surgeries. Therefore, PAS should not be regarded as an absolute contraindication for minimally invasive colorectal surgeries.
既往腹部手术(PAS)对腹腔镜手术和机器人手术的手术结局的影响尚无定论。本研究旨在调查PAS对腹腔镜和机器人结直肠手术围手术期结局的影响。
2007年3月至2014年2月,分别有612例和238例患者接受了腹腔镜手术和机器人手术。患者被分为3组:未进行PAS的患者(NPAS)、进行了大型PAS的患者和进行了小型PAS的患者。我们进一步对患者进行分组,以便我们最终用于分析的组为:腹腔镜组中NPAS患者(n = 478)、大型PAS患者(n = 19)和小型PAS患者(n = 115),以及机器人手术组中NPAS患者(n = 202)和小型PAS患者(n = 36)。
在腹腔镜组中,3组之间的中转率无差异(NPAS = 1.0% vs. 大型PAS = 0% vs. 小型PAS = 1.7%,P = 0.701)。在机器人手术组中,NPAS组和小型PAS组之间的中转率无差异(1.0% vs. 2.8%,P = 0.390)。在各分组中,手术时间、失血量、恢复软食天数、住院时间和并发症发生率均不受PAS影响。
PAS不会危及腹腔镜或机器人结直肠手术的围手术期结局。因此,PAS不应被视为微创结直肠手术的绝对禁忌证。