Does experience with laparoscopic colorectal surgery influence intraoperative outcomes?

被引:17
作者
Bouchard, Alexandre [1 ]
Martel, Guillaume [1 ]
Sabri, Elham [1 ]
Schlachta, Christopher M. [2 ]
Poulin, Eric C. [1 ]
Mamazza, Joseph [1 ]
Boushey, Robin P. [1 ]
机构
[1] Univ Ottawa, Ottawa Hosp, Div Gen Surg, Minimally Invas Surg Res Grp, Ottawa, ON K1H 8L6, Canada
[2] Univ Western Ontario, Dept Surg, London Hlth Sci Ctr, Canadian Surg Technol & Adv Robot, London, ON N6A 3K7, Canada
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2009年 / 23卷 / 04期
关键词
Laparoscopic colorectal surgery; Intraoperative complications; Conversion; Experience; Learning curve; NONOBESE PATIENTS; LEARNING-CURVE; COLON-CANCER; RESECTIONS; CONVERSION; COLECTOMY; COMPLICATIONS; MULTICENTER; OBESITY; TRIAL;
D O I
10.1007/s00464-008-0087-6
中图分类号
R61 [外科手术学];
学科分类号
摘要
This study aimed to define the management and risk factors for intraoperative complications (IOC) and conversion in laparoscopic colorectal surgery, and to assess whether surgeon experience influences intraoperative outcomes. Consecutive patients undergoing laparoscopic colorectal procedures from 1991 to 2005 were analyzed from a longitudinal prospectively collected database. All patients referred to the four surgeons involved in this study were offered a minimally invasive approach. Patient characteristics, perioperative variables, and surgeon experience data were analyzed and compared. A total of 991 consecutive laparoscopic colorectal procedures were studied. The majority of operations were performed for malignant disease (n = 526, 53%), and most frequently consisted of segmental colonic resections (n = 718, 72%). A total of 85 patients (8.6%) had an IOC. Patients experiencing an IOC had a significantly higher median body weight (75 versus 68 kg, p = 0.0047) and had a higher proportion of previous abdominal surgery (31% versus 20%, p = 0.029). Only 39% of patients suffering an IOC required conversion to open surgery. A total of 126 (13%) cases were converted to open surgery. On multivariable analysis, previous abdominal surgery [odds ratio (OR) 3.40, 95% confidence interval (CI) 1.39-8.35, p = 0.0076] was independently associated with having an IOC and a conversion to open within the same procedure. With increasing experience, individual surgeons were found to operate on heavier patients (p = 0.025), and on patients who had a higher rate of previous intra-abdominal surgery (p < 0.0001). Despite these risk factors, the early and late experience demonstrated no significant difference in terms of IOCs (p = 0.54) and conversion to open surgery (p = 0.40). The majority of IOCs can be managed laparoscopically. With increasing experience surgeons can perform laparoscopic colorectal surgery on a patient population with a greater proportion of previous abdominal surgery and a higher mean body weight without adversely affecting their rates of intraoperative complications or conversion.
引用
收藏
页码:862 / 868
页数:7
相关论文
共 24 条
[1]   Intraoperative laparoscopic complications - Are we getting better? [J].
Agachan, F ;
Joo, JS ;
Weiss, EG ;
Wexner, SD .
DISEASES OF THE COLON & RECTUM, 1996, 39 (10) :S14-S19
[2]  
Bennett CL, 1997, ARCH SURG-CHICAGO, V132, P781
[3]   Complications and conversions in laparoscopic colorectal surgery - Results of a multicenter Brazilian trial [J].
Campos, FG .
SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES, 2003, 13 (03) :173-179
[4]   Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction [J].
Chen, J ;
Rathore, SS ;
Wang, YF ;
Radford, MJ ;
Krumholz, HM .
JOURNAL OF GENERAL INTERNAL MEDICINE, 2006, 21 (03) :238-244
[5]   Multidimensional analysis of learning curves in laparoscopic sigmoid resection -: Eight-year results [J].
Dinçler, S ;
Koller, MT ;
Steurer, J ;
Bachmann, LM ;
Christen, D ;
Buchmann, P .
DISEASES OF THE COLON & RECTUM, 2003, 46 (10) :1371-1378
[6]  
Franko Jan, 2006, JSLS, V10, P169
[7]   Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial [J].
Guillou, PJ ;
Quirke, P ;
Thorpe, H ;
Walker, J ;
Jayne, DG ;
Smith, AMH ;
Heath, RM ;
Brown, JM .
LANCET, 2005, 365 (9472) :1718-1726
[8]   Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease [J].
Le Moine, MC ;
Fabre, JM ;
Vacher, C ;
Navarro, F ;
Picot, MC ;
Domergue, J .
BRITISH JOURNAL OF SURGERY, 2003, 90 (02) :232-236
[9]   The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy [J].
Leroy, J ;
Ananian, P ;
Rubino, F ;
Claudon, B ;
Mutter, D ;
Marescaux, J .
ANNALS OF SURGERY, 2005, 241 (01) :69-76
[10]   Laparoscopic colon surgery: Past, present and future [J].
Martel, Guillaume ;
Boushey, Robin P. .
SURGICAL CLINICS OF NORTH AMERICA, 2006, 86 (04) :867-+