Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Mathematical Health Science, Osaka University Graduate School of Medicine Division of Health Sciences, Osaka, Japan.
Ann Surg Oncol. 2019 Dec;26(13):4390-4396. doi: 10.1245/s10434-019-07794-x. Epub 2019 Sep 6.
We assessed the feasibility and safety of single-site laparoscopic surgery for patients with colorectal cancer who required perioperative heparinization.
This retrospective study reviewed the medical records of 390 patients who underwent single-site laparoscopic surgery for colorectal cancer from January 2010 to December 2016. Antithrombotic drugs were stopped preoperatively and heparin was administered according to the operative risk of each patient, based on consultation with the cardiologist physician or neurosurgeon. Propensity score modeling was utilized to adjust for baseline characteristics.
Of 390 patients, 29 were treated with standard bridging intravenous heparin therapy. Propensity matching identified 119 patients: 22 patients in the heparinization group and 97 in the control group. The matched groups were not significantly different in operation times, bleeding volumes, or conversion rate. The mean postoperative hospital stay was 17.9 days in the heparinization group and 9.5 days in the control group (p = 0.034). Postoperative bleeding was observed in 4 patients (18.2%) in the heparinization group and 11 patients (11.4%) in the control group (p = 0.646), while other complications were similar in the two study groups (p = 0.502). Of these other complications, thromboembolic events were observed in two patients in the heparinization group and one patient in the control group.
We found that single-site laparoscopic surgery for colorectal cancer with heparinization was feasible and safe. Heparinization did not increase the risk of postoperative bleeding complications, but postoperative hospital stay was prolonged.
我们评估了需要围手术期肝素化的结直肠癌患者行单部位腹腔镜手术的可行性和安全性。
本回顾性研究纳入了 2010 年 1 月至 2016 年 12 月期间接受单部位腹腔镜结直肠癌手术的 390 例患者的病历资料。根据每位患者的手术风险，在与心脏病专家或神经外科医生协商后，术前停止使用抗血栓药物，并给予肝素。采用倾向评分匹配法调整基线特征。
390 例患者中，29 例行标准桥接静脉内肝素治疗。倾向性评分匹配后共纳入 119 例患者：肝素化组 22 例，对照组 97 例。两组在手术时间、出血量或中转率方面无显著差异。肝素化组的平均术后住院时间为 17.9 天，对照组为 9.5 天（p=0.034）。肝素化组有 4 例（18.2%）患者术后出血，对照组有 11 例（11.4%）患者术后出血（p=0.646），两组其他并发症相似（p=0.502）。在这些其他并发症中，肝素化组有 2 例患者和对照组有 1 例患者发生血栓栓塞事件。
我们发现，结直肠癌的单部位腹腔镜手术联合肝素化是可行且安全的。肝素化并未增加术后出血并发症的风险，但延长了术后住院时间。
