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Laparoscopic surgery improves postoperative outcomes in high-risk patients with colorectal cancer

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Abstract

Background

Patients with significant comorbidities often are denied laparoscopic colorectal resections, because they are thought to be too “high-risk.” This study was designed to examine the feasibility and safety of laparoscopic colorectal resections in high-risk colorectal cancer patients and to compare them with a similar cohort of patients undergoing open resections in the same time period.

Methods

This was a single-center, prospective, cohort study conducted at a high-volume, nonuniversity, tertiary care hospital. From a database of 616 patients submitted to elective colorectal surgery for cancer within a fast-track protocol (January 2005 to November 2011), 188 patients who met at least one minor (age >80 years and body mass index (BMI) >30 m/kg2) and one major (cardiac, pulmonary, renal or liver disease, diabetes mellitus) criterion were classified as high-risk. Differences in baseline characteristics, intraoperative outcomes, and short-term (30-day) postoperative outcomes, as well as the pathology findings and the readmission and reoperation rates, were compared between the open and laparoscopic cohorts in both high- and low-risk groups and between high- and low-risk groups.

Results

During the study period, 68 high-risk patients underwent laparoscopic resections and 120 had open surgeries. A shorter length of postoperative stay (6 vs. 9 days, p < 0.0001) and fewer postoperative nonsurgical complications (4 % vs. 19 %, p = 0.003) were observed among the laparoscopic group. Postoperative major (p = 0.774) and minor complications (p = 0.3) and reoperations (p = 0.196) were similar between the two groups, and a significantly lower rate of mortality (1.5 vs. 7.5 %, p = 0.038) was observed in the laparoscopic group than in the open group.

Conclusions

Laparoscopic colorectal resection can be safely performed on “high-risk” surgical patients with better results than a similar group of high-risk patients undergoing open colon resections.

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Disclosures

Francesco Feroci, Maddalena Baraghini, Elisa Lenzi, Alessia Garzi, Andrea Vannucchi, Stefano Cantafio, and Marco Scatizzi have no conflict of interest or financial ties to disclose.

Funding

There was no financial support for this study.

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Authors and Affiliations

  1. Department of General Surgery, Misericordia e Dolce Hospital, Piazza dell’Ospedale 5, 59100, Prato, PO, Italy

    Francesco Feroci, Maddalena Baraghini, Elisa Lenzi, Alessia Garzi, Andrea Vannucchi, Stefano Cantafio & Marco Scatizzi

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  1. Francesco Feroci
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  2. Maddalena Baraghini
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  3. Elisa Lenzi
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  4. Alessia Garzi
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  5. Andrea Vannucchi
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  6. Stefano Cantafio
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  7. Marco Scatizzi
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Corresponding author

Correspondence to Francesco Feroci.

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Feroci, F., Baraghini, M., Lenzi, E. et al. Laparoscopic surgery improves postoperative outcomes in high-risk patients with colorectal cancer. Surg Endosc 27, 1130–1137 (2013). https://doi.org/10.1007/s00464-012-2559-y

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  • DOI: https://doi.org/10.1007/s00464-012-2559-y

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