Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial
- 444 Downloads
Postoperative bowel obstruction caused by intra-abdominal adhesions occurs after all types of abdominal surgery. It has been suggested that the laparoscopic technique should reduce the risk for adhesion formation and thus for postoperative bowel obstruction. This study was designed to compare the incidence of bowel obstruction in a randomized trial where laparoscopic and open resection for colon cancer was compared.
A retrospective analysis was performed, collecting data of episodes of bowel obstruction with or without surgery. Only episodes treated in the hospital where the index surgery took place were included. Data for 786 patients were collected for the 5-year period after cancer surgery.
Baseline characteristics for the evaluated laparoscopic (n = 383) and open (n = 403) groups were comparable. The cumulative obstruction percentages at 5 years for the open and laparoscopic groups were 6.5 and 5.1% respectively and did not significantly differ from each other. Tumor stage seemed to influence the risk for bowel obstruction: 2.8% in stage I, 6.6% in stage II, and 7% in stage III, but the differences were not significant.
This analysis does not support the hypothesis that laparoscopy leads to fewer episodes of bowel obstruction compared with open surgery.
KeywordsColorectal cancer Surgical technique Complications Adhesions Bowel obstruction Laparoscopy
The authors express their sincere gratitude to RN Elisabet Lindholm, Dr. Gunnar Edlund, Dr. Johan Dalen, Dr. Owe Lundberg, and Dr. Ulf Kressner who all made significant contributions to make this report possible. This work was supported by grants from Sahlgrenska University Hospital, Sahlgrenska Academy at University of Gothenburg and the Swedish Cancer Foundation.
Dr. Lacy is a Consultant for Covidien and for Olympus Medical. Dr. Buunen presently works as Senior Medical Advisor for Grunenthal GmbH, Aachen. Authors Anderberg, Bonjer, Cuesta, Delgado, Haglind, Hop, Ibarzabal, Ivarsson, Janson, Lange, Påhlman, Skullman, and Schölin have no conflicts of interest or financial ties to disclose.
- 17.Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059Google Scholar
- 18.Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRefGoogle Scholar