Bizzoca Cinzia, Zupo Roberta, Aquilino Fabrizio, Castellana Fabio, Fiore Felicia, Sardone Rodolfo, Vincenti Leonardo
General Surgery Unit "Ospedaliera", University Hospital "Policlinico" of Bari, 70124 Bari, Italy.
Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.
Cancers (Basel). 2021 Apr 13;13(8):1844. doi: 10.3390/cancers13081844.
Minimally invasive surgery in obese patients is still challenging, so exploring one more item in this research field ranks among the main goals of this research. We aimed to compare short-term postoperative outcomes of open and video-laparoscopic (VL) approaches in CRC obese patients undergoing colorectal resection. We performed a retrospective analysis of a surgical database including 138 patients diagnosed with CRC, undergoing VL ( = 87, 63%) and open ( = 51, 37%) colorectal surgery. As a first step, propensity score matching was performed to balance the comparison between the two intervention groups (VL and open) in order to avoid selection bias. The matched sample ( = 98) was used to run further regression models in order to analyze the observed VL surgery advantages in terms of postoperative outcome, focusing on hospitalization and severity of postoperative complications, according to the Clavien-Dindo classification. The study sample was predominantly male ( = 86, 62.3%), and VL was more frequent than open surgery (63% versus 37%). The two subgroup results obtained before and after the propensity score matching showed comparable findings for age, gender, BMI, and tumor staging. The specimen length and postoperative time before discharge were longer in open surgery (OS) patients; the number of harvested lymph nodes was higher than in VL patients as well ( < 0.01). Linear regression models applied separately on the outcomes of interest showed that VL-treated patients had a shorter hospital stay by almost two days and about one point less Clavien-Dindo severity than OS patients on average, given the same exposure to confounding variables. Tumor staging was not found to have a significant role in influencing the short-term outcomes investigated. Comparing open and VL surgery, improved postoperative outcomes were observed for VL surgery in obese patients after surgical resection for CRC. Both postoperative recovery time and Clavien-Dindo severity were better with VL surgery.
在肥胖患者中进行微创手术仍然具有挑战性，因此在这一研究领域探索更多内容是本研究的主要目标之一。我们旨在比较接受结直肠切除术的肥胖结直肠癌（CRC）患者采用开放手术和视频腹腔镜（VL）手术的术后短期结局。我们对一个手术数据库进行了回顾性分析，该数据库包含138例被诊断为CRC的患者，其中87例（63%）接受了VL手术，51例（37%）接受了开放结直肠手术。第一步，进行倾向得分匹配以平衡两个干预组（VL组和开放手术组）之间的比较，以避免选择偏倚。匹配后的样本（n = 98）用于进一步运行回归模型，以便根据Clavien-Dindo分类分析观察到的VL手术在术后结局方面的优势，重点关注住院时间和术后并发症的严重程度。研究样本以男性为主（n = 86，62.3%），VL手术比开放手术更常见（63%对37%）。倾向得分匹配前后获得的两个亚组结果在年龄、性别、BMI和肿瘤分期方面显示出可比的结果。开放手术（OS）患者的标本长度和术后出院前时间更长；所获取的淋巴结数量也高于VL手术患者（P < 0.01）。分别对感兴趣的结局应用线性回归模型表明，在接触相同混杂变量的情况下，VL治疗的患者平均住院时间比OS患者短近两天，Clavien-Dindo严重程度平均低约一分。未发现肿瘤分期对所研究的短期结局有显著影响。比较开放手术和VL手术，肥胖CRC患者手术切除后，VL手术的术后结局得到改善。VL手术的术后恢复时间和Clavien-Dindo严重程度均更好。
