腹腔镜结肠切除术治疗美国麻醉医师协会分级较差的患者。

Laparoscopic colectomy for patients with poor American Society of Anesthesiology classifications.

机构信息

Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.

Department of Surgery, Sasebo City General Hospital, Nagasaki, Japan.

出版信息

Asian J Endosc Surg. 2024 Oct;17(4):e13393. doi: 10.1111/ases.13393.

DOI:10.1111/ases.13393

PMID:39354703

Abstract

INTRODUCTION

The American Society of Anesthesiologists (ASA) classification is used to assess the fitness of a patient for surgery. Whether laparoscopic surgery is appropriate for colorectal cancer patients with poor ASA performance status (PS) remains unclear.

METHODS

Among 4585 patients who underwent colorectal surgery between 2016 and 2023, this study retrospectively reviewed all 458 patients with ASA-PS ≥3. Patients were divided into two groups: patients treated by open surgery (O group, n = 80); and patients treated by laparoscopic surgery (L group, n = 378). We investigated the impact of surgical approach on postoperative complications in patients with colorectal cancer and ASA-PS ≥3.

RESULTS

Operation time was longer (170 min vs. 233 min, p < .001), blood loss was less (156 mL vs. 23 mL, p < .001), postoperative complications were less frequent (40.0% vs. 25.1%, p = .008), and hospital stay was shorter (23 days vs. 14 days, p < .001) in L group. Univariate analysis revealed rectal cancer, open surgery, longer operation time, and blood loss as factors significantly associated with postoperative complications. Multivariate analysis revealed open surgery (odds ratio [OR] 2.100, 95% confidence interval [CI] 1.164-3.788; p = .013) and longer operation time (OR 1.747, 95% CI 1.098-2.778; p = .018) as independent predictors of postoperative complications.

CONCLUSION

Laparoscopic surgery provides favorable outcomes for colorectal cancer patients with poor ASA-PS.

摘要

简介

美国麻醉医师学会（ASA）分级用于评估患者接受手术的健康状况。对于 ASA 表现状态（PS）较差的结直肠癌患者，腹腔镜手术是否合适尚不清楚。

方法

在 2016 年至 2023 年间接受结直肠手术的 4585 名患者中，本研究回顾性分析了所有 458 名 ASA-PS≥3 的患者。患者分为两组：接受开放手术（O 组，n=80）和腹腔镜手术（L 组，n=378）。我们研究了手术方式对 ASA-PS≥3 的结直肠癌患者术后并发症的影响。

结果

手术时间更长（170 分钟 vs. 233 分钟，p<0.001），出血量更少（156 毫升 vs. 23 毫升，p<0.001），术后并发症发生率更低（40.0% vs. 25.1%，p=0.008），住院时间更短（23 天 vs. 14 天，p<0.001）。单因素分析显示，直肠癌、开放手术、手术时间长和出血量与术后并发症显著相关。多因素分析显示，开放手术（比值比 [OR] 2.100，95%置信区间 [CI] 1.164-3.788；p=0.013）和手术时间长（OR 1.747，95% CI 1.098-2.778；p=0.018）是术后并发症的独立预测因素。