Laparoscopic sigmoid resection for diverticular disease has no advantages over open approach: midterm results of a randomized controlled trial

  • Wieland Raue
  • V. Paolucci
  • W. Asperger
  • R. Albrecht
  • M. W. Büchler
  • W. Schwenk
  • for the LAPDIV-CAMIC Trial Group
Rapid Communication

Abstract

Purpose

Elective laparoscopic sigmoid resection (LSR) for symptomatic diverticular disease is supposed to have significant short-term advantages compared to open surgery (open sigmoid resection (OSR)). This opinion is rather based on inferences from trials on colonic resections for malignant diseases or minor laparoscopic surgery. This randomized controlled trial was conducted to compare quality of life as well as morbidity and clinical outcome after LSR vs. OSR following a midterm follow-up period.

Methods

Patients presenting with a symptomatic sigmoid diverticular disease stage II/III (Stock/Hansen) were randomly allocated to LSR or OSR in a prospective multicenter trial. Endpoints included the quality of life assessed with a standardized questionnaire, postoperative mortality, and complications within the follow-up of 12 months after operation.

Results

A total of 143 patients randomized between 2005 and 2008 in 12 centers could be analyzed. The recruitment was aborted for nonachievement of the planned sample size. Seventy-five patients were allocated to LSR, and 68 received OSR. Nine operations were converted to OSR (9%) and analyzed as intention to treat. Groups were comparable for age, gender, body mass index, comorbidity, and indication for surgery. Operation time was longer for LSR (p < 0.001). Quality of life did not differ between LSR and OSR, either during the early postoperative course or after 12 months (p = 0.172). Also, mortality and morbidity, including subgroups of major and minor morbidity, were compared.

Conclusion

LSR was not superior to OSR regarding postoperative quality of life and incidence of complications in this trial.

Keywords

RCT Laparoscopy Diverticulitis Surgery Quality of life 

References

  1. 1.
    Barlehner E, Heukrodt B, Schwetling R (1998) Laparoscopic surgery of sigmoid diverticulitis. Zentralbl Chir 123(Suppl):13–16PubMedGoogle Scholar
  2. 2.
    Wong WD, Wexner SD, Lowry A, Vernava A III, Burnstein M, Denstman F, Fazio V, Kerner B, Moore R, Oliver G, Peters W, Ross T, Senatore P, Simmang C (2000) Practice parameters for the treatment of sigmoid diverticulitis–supporting documentation. The Standards Task Force. The American Society of Colon and Rectal Surgeons. Dis Colon Rectum 43:290–297PubMedCrossRefGoogle Scholar
  3. 3.
    Oomen JL, Engel AF, Cuesta MA (2006) Outcome of elective primary surgery for diverticular disease of the sigmoid colon: a risk analysis based on the POSSUM scoring system. Colorectal Dis 8:91–97PubMedCrossRefGoogle Scholar
  4. 4.
    Schmedt CG, Bittner R, Schroter M, Ulrich M, Leibl B (2000) Surgical therapy of colonic diverticulitis—how reliable is primary anastomosis? Chirurg 71:202–208PubMedCrossRefGoogle Scholar
  5. 5.
    Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon Rectum 45:1309–1314PubMedCrossRefGoogle Scholar
  6. 6.
    Jones OM, Stevenson AR, Clark D, Stitz RW, Lumley JW (2008) Laparoscopic resection for diverticular disease: follow-up of 500 consecutive patients. Ann Surg 248:1092–1097PubMedCrossRefGoogle Scholar
  7. 7.
    Kockerling F, Schneider C, Reymond MA, Scheidbach H, Scheuerlein H, Konradt J, Bruch HP, Zornig C, Kohler L, Barlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group. Surg Endosc 13:567–571PubMedCrossRefGoogle Scholar
  8. 8.
    Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg 249:39–44PubMedCrossRefGoogle Scholar
  9. 9.
    Gervaz P, Inan I, Perneger T, Schiffer E, Morel P (2010) A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis. Ann Surg 252:3–8PubMedCrossRefGoogle Scholar
  10. 10.
    Hansen O, Stock W (1999) Prophylaktische Operation bei der Divertikelkrankheit des Kolons—Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Surg (Suppl II):1257–1260Google Scholar
  11. 11.
    Bemelman WA, Ringers J, Meijer DW, de Wit CW, Bannenberg JJ (1996) Laparoscopic-assisted colectomy with the dexterity pneumo sleeve. Dis Colon Rectum 39:S59–S61PubMedCrossRefGoogle Scholar
  12. 12.
    Alves A, Panis Y, Slim K, Heyd B, Kwiatkowski F, Mantion G (2005) French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease. Br J Surg 92:1520–1525PubMedCrossRefGoogle Scholar
  13. 13.
    Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 138:1179–1186PubMedCrossRefGoogle Scholar
  14. 14.
    Purkayastha S, Constantinides VA, Tekkis PP, Athanasiou T, Aziz O, Tilney H, Darzi AW, Heriot AG (2006) Laparoscopic vs. open surgery for diverticular disease: a meta-analysis of nonrandomized studies. Dis Colon Rectum 49:446–463PubMedCrossRefGoogle Scholar
  15. 15.
    Scheidbach H, Schneider C, Rose J, Konradt J, Gross E, Bärlehner E, Pross M, Schmidt U, Köckerling F, Lippert H (2004) Laparoscopic approach to treatment of sigmoid diverticulitis: changes in the spectrum of indications and results of a prospective multicenter study on 1,545 patients. Dis Colon Rectum 47:1883–1888PubMedCrossRefGoogle Scholar
  16. 16.
    Senagore A (2005) Laparoscopic sigmoid colectomy for diverticular disease. Surg Clin N Am 85:19–24PubMedCrossRefGoogle Scholar
  17. 17.
    Klarenbeek BR, Bergamaschi R, Veenhof AA, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Cuesta MA (2011) Laparoscopic versus open sigmoid resection for diverticular disease: follow-up assessment of the randomized control Sigma trial. Surg Endosc 25:1121–1126PubMedCrossRefGoogle Scholar
  18. 18.
    Basse L, Jakobsen DH, Bardram L, Billesbolle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241:416–423PubMedCrossRefGoogle Scholar
  19. 19.
    King PM, Blazeby JM, Ewings P, Franks PJ, Longman RJ, Kendrick AH, Kipling RM, Kennedy RH (2006) Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg 93:300–308PubMedCrossRefGoogle Scholar
  20. 20.
    Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ (2008) Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev (2):CD003432Google Scholar
  21. 21.
    Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (3):CD003145Google Scholar
  22. 22.
    Schwenk W, Haase O, Gunther N, Neudecker J (2007) Methodological quality of randomised controlled trials comparing short-term results of laparoscopic and conventional colorectal resection. Int J Colorectal Dis 22:1369–1376PubMedCrossRefGoogle Scholar
  23. 23.
    Scarpa M, Griggio L, Rampado S, Ruffolo C, Citton M, Pozza A, Borsetto L, Dall’olmo L, Angriman I (2011) Long-term health-related quality of life after minimally invasive surgery for diverticular disease. Langenbecks Arch Surg. doi:10.1007/s00423-011-0749-z:
  24. 24.
    McDonald AM, Knight RC, Campbell MK, Entwistle VA, Grant AM, Cook JA, Elbourne DR, Francis D, Garcia J, Roberts I, Snowdon C (2006) What influences recruitment to randomised controlled trials? A review of trials funded by two UK funding agencies. Trials 7:9PubMedCrossRefGoogle Scholar
  25. 25.
    Plaisier PW, Berger MY, van der Hul RL, Nijs HG, den Toom R, Terpstra OT, Bruining HA (1994) Unexpected difficulties in randomizing patients in a surgical trial: a prospective study comparing extracorporeal shock wave lithotripsy with open cholecystectomy. World J Surg 18:769–772PubMedCrossRefGoogle Scholar
  26. 26.
    Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, Colthart IR, Ross S, Shepherd SM, Russell D (1999) Factors that limit the quality, number and progress of randomised controlled trials. Health Technol Assess 3:1–143PubMedGoogle Scholar
  27. 27.
    Ross S, Grant A, Counsell C, Gillespie W, Russell I, Prescott R (1999) Barriers to participation in randomised controlled trials: a systematic review. J Clin Epidemiol 52:1143–1156PubMedCrossRefGoogle Scholar
  28. 28.
    Braga M, Frasson M, Vignali A, Zuliani W, Di Carlo V (2007) Open right colectomy is still effective compared to laparoscopy: results of a randomized trial. Ann Surg 246:1010–1014PubMedCrossRefGoogle Scholar
  29. 29.
    Mackay G, Ihedioha U, McConnachie A, Serpell M, Molloy RG, O’Dwyer PJ (2007) Laparoscopic colonic resection in fast-track patients does not enhance short-term recovery after elective surgery. Colorectal Dis 9:368–372PubMedCrossRefGoogle Scholar
  30. 30.
    Vlug MS, Wind J, van der Zaag E, Ubbink DT, Cense HA, Bemelman WA (2009) Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme. Colorectal Dis 11:335–343PubMedCrossRefGoogle Scholar
  31. 31.
    Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809PubMedCrossRefGoogle Scholar
  32. 32.
    Wind J, Hofland J, Preckel B, Hollmann MW, Bossuyt PM, Gouma DJ, van Berge Henegouwen MI, Fuhring JW, Dejong CH, van Dam RM, Cuesta MA, Noordhuis A, de Jong D, van Zalingen E, Engel AF, Goei TH, de Stoppelaar IE, van Tets WF, van Wagensveld BA, Swart A, van den Elsen MJ, Gerhards MF, de Wit LT, Siepel MA, van Geloven AA, Juttmann JW, Clevers W, Bemelman WA (2006) Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial). BMC Surg 6:16PubMedCrossRefGoogle Scholar
  33. 33.
    Schwenk W, Neudecker J, Haase O, Raue W, Strohm T, Muller JM (2004) Comparison of EORTC quality of life core questionnaire (EORTC-QLQ-C30) and gastrointestinal quality of life index (GIQLI) in patients undergoing elective colorectal cancer resection. Int J Colorectal Dis 19:554–560PubMedCrossRefGoogle Scholar
  34. 34.
    Dowson H, Cowie A, Ballard K, Gage H, Rockall T (2008) Systematic review of quality of life following laparoscopic and open colorectal surgery. Colorectal Dis 10:757–768CrossRefGoogle Scholar
  35. 35.
    Fredheim OM, Borchgrevink PC, Saltnes T, Kaasa S (2007) Validation and comparison of the health-related quality-of-life instruments EORTC QLQ-C30 and SF-36 in assessment of patients with chronic nonmalignant pain. J Pain Symptom Manage 34:657–665PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Wieland Raue
    • 1
    • 7
  • V. Paolucci
    • 2
  • W. Asperger
    • 3
  • R. Albrecht
    • 4
  • M. W. Büchler
    • 5
  • W. Schwenk
    • 6
  • for the LAPDIV-CAMIC Trial Group
  1. 1.Department of General, Visceral, Vascular and Thoracic SurgeryCharité–University Medicine BerlinBerlinGermany
  2. 2.Department of General and Visceral SurgeryKetteler Krankenhaus OffenbachOffenbachGermany
  3. 3.Department of General and Visceral SurgeryKrankenhaus St. Elisabeth u. St. Barbara HalleHalleGermany
  4. 4.Department of Visceral and Vascular SurgeryHELIOS Klinikum AueErfurtGermany
  5. 5.Department of General, Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany
  6. 6.Department of General and Visceral SurgeryAsklepios Klinik AltonaHamburgGermany
  7. 7.Klinik für Allgemein-, Visceral-, Gefäß- und ThoraxchirurgieCharité–Universitätsmedizin BerlinBerlinGermany

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