Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study)

被引:78
作者
Bartels, S. A. L. [1 ]
Vlug, M. S. [1 ]
Hollmann, M. W. [2 ]
Dijkgraaf, M. G. W. [3 ]
Ubbink, D. T. [4 ]
Cense, H. A. [7 ]
van Wagensveld, B. A. [5 ]
Engel, A. F. [8 ]
Gerhards, M. F. [6 ]
Bemelman, W. A. [1 ]
机构
[1] Acad Med Ctr, Dept Surg, NL-1100 DD Amsterdam, Netherlands
[2] Acad Med Ctr, Dept Anesthesiol, NL-1100 DD Amsterdam, Netherlands
[3] Acad Med Ctr, Clin Res Unit, NL-1100 DD Amsterdam, Netherlands
[4] Acad Med Ctr, Dept Qual Assurance & Proc Innovat, NL-1100 DD Amsterdam, Netherlands
[5] Sint Lucas Andreas Hosp, Dept Surg, Amsterdam, Netherlands
[6] Onze Lieve Vrouw Hosp, Dept Surg, Amsterdam, Netherlands
[7] Red Cross Hosp, Dept Surg, Beverwijk, Netherlands
[8] Zaans Med Ctr, Dept Surg, Zaandam, Netherlands
关键词
QUALITY-OF-LIFE; OPEN COLORECTAL SURGERY; ULCERATIVE-COLITIS; ADHESIONS; CANCER; VALIDATION; LAPAROTOMY; ADMISSIONS; COLECTOMY; TRIAL;
D O I
10.1002/bjs.9585
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Short-term advantages to laparoscopic surgery are well described. This study compared medium-to long-term outcomes of a randomized clinical trial comparing laparoscopic and open colonic resection for cancer. Methods: The case notes of patients included in the LAFA study (perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care) were reviewed 2-5 years after randomization for incisional hernia, adhesional small bowel obstruction (SBO), overall survival, cancer recurrence and quality of life (QoL). The laparoscopic and open groups were compared irrespective of fast-track or standard perioperative care. Results: Data on incisional hernias, SBO, survival and recurrence were available for 399 of 400 patients: 208 laparoscopic and 191 open resections. These outcomes were corrected for duration of follow-up. Median follow-up was 3.4 (i.q.r. 2.6-4.4) years. Multivariable regression analysis showed that open resection was a risk factor for incisional hernia (odds ratio (OR) 2.44, 95 per cent confidence interval (c.i.) 1.12 to 5.26; P = 0.022) and SBO (OR 3.70, 1.07 to 12.50; P = 0.039). There were no differences in overall survival (hazard ratio 1 10, 95 per cent c.i. 0.67 to 1.80; P = 0.730) or in cumulative incidence of recurrence (P = 0.514) between the laparoscopic and open groups. There were no measured differences in QoL in 281 respondents (P > 0.350 for all scales). Conclusion: Laparoscopic colonic surgery led to fewer incisional hernia and adhesional SBO events.
引用
收藏
页码:1153 / 1159
页数:7
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