Department of Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokura-kita, Kitakyushu, Fukuoka, 802-8555, Japan.
World J Surg Oncol. 2019 Jun 1;17(1):92. doi: 10.1186/s12957-019-1634-4.
Laparoscopic abdominal surgery is considered superior to open surgery. However, efficacy and safety outcomes of laparoscopic surgery in colorectal cancer (CRC) are unclear, particularly in patients undergoing antiplatelet therapy (APT). The aim of this study was to evaluate safety of antiplatelet agents, especially aspirin, in peri-operative management of patients undergoing laparoscopic colorectal resection for CRC.
A total of 578 radical laparoscopic colorectal surgeries in CRC patients performed between January 2005 and December 2015 at the Kokura Memorial Hospital were retrospectively reviewed. Patients were divided into three groups based on the risk for thromboembolism: a high-risk group receiving APT (APT-HR), a low-risk group receiving APT (APT-LR), and a low-risk group not receiving APT (non-APT). Bleeding complications (BC) and thromboembolic complications (TC) were assessed. Perioperative and outcome variables in groups receiving APT were compared with those in the non-APT group.
APT-HR, APT-LR, and non-APT groups included 54 (9.3%), 114 (19.7%), and 410 (70.9%) patients, respectively. Blood loss during operation (p = 0.304), operative time (p = 0.956), hospitalisation after surgery (p = 0.307), and Clavien-Dindo classification of surgery-related complications (p = 0.467) were not significantly different in the three groups. Occurrence of intra-operative BC (blood loss ≥ 200 ml) (p = 0.864), post-operative BC (p = 0.630), and TC (p = 0.287) were also not significantly different in the three groups. Results of our analysis indicated that APT and non-interrupted APT were not associated with BC or TC.
Analysis of laparoscopic colorectal resection in CRC showed that APT was not a major factor for fatal BC or TC. In patients with high thromboembolic risk, continuing aspirin may inhibit the increase in TC without increasing BC in the peri-operative period.
腹腔镜腹部手术被认为优于开放手术。然而，在结直肠癌（CRC）患者中，腹腔镜手术的疗效和安全性结果尚不清楚，特别是在接受抗血小板治疗（APT）的患者中。本研究旨在评估抗血小板药物（尤其是阿司匹林）在接受腹腔镜结直肠切除术的 CRC 患者围手术期管理中的安全性。
回顾性分析 2005 年 1 月至 2015 年 12 月在小仓纪念医院行 578 例根治性腹腔镜结直肠手术的 CRC 患者的临床资料。根据血栓栓塞风险将患者分为三组：高风险组接受 APT（APT-HR）、低风险组接受 APT（APT-LR）和低风险组不接受 APT（非 APT）。评估出血并发症（BC）和血栓栓塞并发症（TC）。比较接受 APT 与非 APT 组的围手术期和结局变量。
APT-HR、APT-LR 和非 APT 组分别包括 54（9.3%）、114（19.7%）和 410（70.9%）例患者。三组患者术中出血量（p=0.304）、手术时间（p=0.956）、术后住院时间（p=0.307）和手术相关并发症的 Clavien-Dindo 分级（p=0.467）差异均无统计学意义。三组患者术中 BC（出血量≥200ml）（p=0.864）、术后 BC（p=0.630）和 TC（p=0.287）的发生率差异均无统计学意义。本分析结果表明，APT 和非中断 APT 与 BC 或 TC 无关。
分析腹腔镜结直肠切除术在 CRC 中的应用结果表明，APT 不是致命性 BC 或 TC 的主要因素。在高血栓栓塞风险患者中，继续使用阿司匹林可能会抑制围手术期 TC 的增加，而不会增加 BC。
