Laparoscopic colectomy was considered initially to be contraindicated in patients at high risk for operative morbidity and mortality. We hypothesized that this procedure is safe to perform in high-risk patients, stratifying this risk using National VA Surgical Quality Improvement Program (NSQIP) algorithms.
A case-matched, comparative study was performed for high-risk veteran patients who underwent colectomy during the period October 2002–September 2004. Consecutive patients undergoing laparoscopic colectomy were matched to patients who underwent open colectomy during the same period for age, body mass index (BMI), procedure, and NSQIP-predicted risk. The groups were compared for risk-stratified, 30-day morbidity/mortality, length of stay (LOS), and operating time.
Forty-five patients (23 laparoscopic and 22 open cases) were defined as at high risk for complications (predicted complication >0.15). The rate of major complications was significantly less in the laparoscopic group. There were 4 (18%) cases of postoperative respiratory failure in the open group and none in the laparoscopic group. There was no surgically related mortality in the laparoscopic group, compared with 2 deaths in the open group (P = .5). Median LOS was less in the laparoscopic group (5 days) compared with open (8 days) (P = .001). There were no significant differences in operating time or the number of minor complications.
Our results suggest that the laparoscopic approach to colorectal diseases is safe in the population of patients at high risk for operative morbidity and mortality. Rather, this approach may represent a safer alternative to open access.
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- Minimally invasive colon resection (laparoscopic colectomy).Surg Laparosc Endosc. 1991; 1: 144-150
- A comparison of laparoscopically assisted and open colectomy for colon cancer.N Engl J Med. 2004; 350: 2050-2059
- Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome.Ann Surg. 2002; 236: 759-766
- Laparoscopic colectomy for benign colorectal disease is associated with a significant reduction in disability as compared with laparotomy.Surg Endosc. 1998; 12: 1397-1400
- Prospective comparison of open vs. laparoscopic colon surgery for carcinoma.Dis Colon Rectum. 1996; 39: S35-S46
- Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma.Surg Endosc. 1995; 9: 811-816
- Postoperative pain and fatigue after laparoscopic or conventional colorectal resections.Surg Endosc. 1998; 12: 1131-1136
- COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer.Surg Endosc. 2002; 16: 949-953
- Laparoscopic colorectal surgery in the complicated patient.Am J Surg. 2005; 190: 882-885
- The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care.Ann Surg. 1998; 228: 491-507
- Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery.Ann Surg. 2000; 232: 242-253
- Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study.Arch Surg. 1999; 134: 36-42
- Laparoscopic colon resection for cancer.Adv Surg. 2006; 40: 59-76
- Pulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation.Arch Surg. 1999; 134: 6-12
- Economic evaluation of minimally invasive colectomy.J Am Coll Surg. 2006; 202: 269-274
Accepted: July 1, 2007
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
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- ErratumSurgeryVol. 143Issue 2
- PreviewAs a result of a production error, several articles appearing in the Central Surgical Association (Surgery, 2007; Vol. 142, No. 4:433-644) and American Association of Endocrine Surgeons (Surgery, 2007; Vol. 142, No. 6:785-1030) special focus issues were published without their respective discussions. The articles affected have now been updated online to include the missing discussion material. Surgery apologizes to the authors for this significant oversight.