Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama, 224-8503, Japan.
Surg Endosc. 2019 Jun;33(6):1769-1776. doi: 10.1007/s00464-018-6449-9. Epub 2018 Oct 5.
The number of colorectal cancer cases is increasing, and so the number of laparoscopic colectomy procedures being performed is also increasing, leading to an increased workload for surgeons. However, operating for prolonged time periods may cause surgeons to lose their concentration and develop fatigue. We hypothesized that there is a time-of-day variation in outcome for patients with colorectal cancer who undergo laparoscopic colectomy. The present study aimed to compare the operative outcome between laparoscopic colectomy for colorectal cancer performed in the morning versus the afternoon.
This was a single-center, retrospective study. All 1961 consecutive patients who underwent laparoscopic surgery for colorectal cancer between 2007 and 2017 were included; 1006 of these patients underwent morning surgery, while 955 underwent afternoon surgery. These patients were analyzed using propensity score matching, giving 791 patients in each group. The short- and long-term outcomes in both groups were compared.
Before propensity score matching, the morning group had a larger mean tumor size than the afternoon group (30 cm vs 35 cm; P = 0.0035). After matching, the two groups did not significantly differ in any patient characteristics. Compared with the afternoon group, the morning group had a significantly lesser incidence of intra-operative organ injury (0.25% vs 1.13%; P = 0.027), and a significantly greater incidence of post-operative abdominal abscess (2.03% vs 0.75% P = 0.028). The incidences of other complications and morbidities were similar in both groups. The median operative time in the morning group (201 min) was significantly longer than that in the afternoon group (193 min; P = 0.0124). The two groups did not differ in 5-year overall survival rates and 5-year disease-free rates within any disease stage.
Surgical start times are correlated with surgical outcomes. Our data will help to ensure the safest possible surgeries.
结直肠癌的病例数量正在增加，因此腹腔镜结肠切除术的数量也在增加，这给外科医生带来了更大的工作量。然而，长时间手术可能会导致外科医生注意力不集中和疲劳。我们假设腹腔镜结肠切除术治疗结直肠癌患者的手术结果存在时间变化。本研究旨在比较上午和下午进行腹腔镜结直肠癌手术的手术结果。
这是一项单中心回顾性研究。纳入 2007 年至 2017 年间接受腹腔镜结直肠癌手术的 1961 例连续患者；其中 1006 例患者接受上午手术，955 例患者接受下午手术。使用倾向评分匹配分析这些患者，每组 791 例。比较两组患者的短期和长期结果。
在进行倾向评分匹配之前，上午组的肿瘤平均大小大于下午组（30cm 比 35cm；P=0.0035）。匹配后，两组患者的任何患者特征均无显著差异。与下午组相比，上午组术中器官损伤发生率显著较低（0.25%比 1.13%；P=0.027），术后腹部脓肿发生率显著较高（2.03%比 0.75%；P=0.028）。两组其他并发症和发病率相似。上午组的中位手术时间（201 分钟）明显长于下午组（193 分钟；P=0.0124）。两组在任何疾病阶段的 5 年总生存率和 5 年无病生存率均无差异。
手术开始时间与手术结果相关。我们的数据将有助于确保手术的安全性。
