Abstract
Background
The impact of surgical approach on the incidence of small bowel obstruction (SBO) is unclear. The aim of the current study was to analyze the long-term risk of surgery for SBO after open and laparoscopic surgery and to assess how subsequent SBO surgery impacts on mortality after colonic cancer resection.
Methods
This was a nationwide cohort study of patients undergoing elective colonic cancer resection with primary anastomosis in Denmark between 2001 and 2008. All included patients were operated with curative intent. Patients were identified in the Danish Colorectal Cancer Group database and followed through May 2014 in the Danish National Patient Register. The primary endpoint was surgery for SBO. Secondarily, mortality among patients who subsequently underwent SBO surgery and those who did not was compared.
Results
Among the 8583 included patients, 251 (2.9 %) underwent surgery for SBO during follow-up (median 8.8 years). The 3-year cumulative incidence of SBO surgery was 1.5 %; 1.2 % after laparoscopic and 1.6 % after open surgery. Laparoscopic surgery was associated with a decreased risk of SBO (hazard ratio [HR] 0.61 (CI 0.37 to 0.99, P = 0.048) compared with open surgery. The HR for mortality after colonic resection was 2.54 (CI 1.91 to 3.38, P < 0.001) for patients who underwent subsequent SBO surgery as compared to those who did not.
Conclusions
Laparoscopic surgery for colonic cancer was associated with a decreased risk of subsequent SBO surgery compared with open surgery. Further, subsequent SBO surgery was associated with increased mortality after colonic cancer resection.
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References
Danish Colorectal Cancer Group (2014) Danish Colorectal Cancer Group Year Report 2014. 8 November 2015 [cited 2015 8 November]; Available from: http://dccg.dk/03_Publikation/2014.pdf
Yeo H, Niland J, Milne D, ter Veer A, Bekaii-Saab T, Farma JM, Lai L, Skibber JM, Small W Jr, Wilkinson N, Schrag D, Weiser MR (2015) Incidence of minimally invasive colorectal cancer surgery at national comprehensive cancer network centers. J Natl Cancer Inst 107:362
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev (3):CD003145
Colon Cancer Laparoscopic or Open Resection Study G, Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52
Hull TL, Joyce MR, Geisler DP, Coffey JC (2012) Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg 99:270–275
Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC, Parker MC, Guillou PJ (2010) Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. Br J Surg 97:70–78
Burns EM, Currie A, Bottle A, Aylin P, Darzi A, Faiz O (2013) Minimal-access colorectal surgery is associated with fewer adhesion-related admissions than open surgery. Br J Surg 100:152–159
Scholin J, Buunen M, Hop W, Bonjer J, Anderberg B, Cuesta M, Delgado S, Ibarzabal A, Ivarsson ML, Janson M, Lacy A, Lange J, Pahlman L, Skullman S, Haglind E (2011) Bowel obstruction after laparoscopic and open colon resection for cancer: results of 5 years of follow-up in a randomized trial. Surg Endosc 25:3755–3760
Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM, Surgical Clinical Adhesions, Research G (2005) The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis 7:551–558
Barmparas G, Branco BC, Schnuriger B, Lam L, Inaba K, Demetriades D (2010) The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg 14:1619–1628
Tingstedt B, Isaksson J, Andersson R (2007) Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions. Br J Surg 94:743–748
Menzies D, Parker M, Hoare R, Knight A (2001) Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions. Ann R Coll Surg Engl 83:40–46
Gogenur I, Ingeholm P, Iversen LH (2012) Danish colorectal cancer database. Ugeskr Laeger 174:2525
Krarup PM, Jorgensen LN, Andreasen AH, Harling H, Danish Colorectal Cancer Group (2012) A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 14:e661–e667
Lynge E, Sandegaard JL, Rebolj M (2011) The Danish national patient register. Scand J Public Health 39:30–33
Norskov AK, Rosenstock CV, Wetterslev J, Astrup G, Afshari A, Lundstrom LH (2015) Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish anaesthesia database. Anaesthesia 70:272–281
Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H (2015) Association of comorbidity with anastomotic leak, 30-day mortality, and length of stay in elective surgery for colonic cancer: a nationwide cohort study. Dis Colon Rectum 58:668–676
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:e296
Martinussen T, Scheike T (2006) Dynamic regression models for survival data. Springer, New York
Gerds TA, Scheike TH, Andersen PK (2012) Absolute risk regression for competing risks: interpretation, link functions, and prediction. Stat Med 31:3921–3930
Eriksson F, Li J, Scheike T, Zhang MJ (2015) The proportional odds cumulative incidence model for competing risks. Biometrics 71:687–695
Xu Q, Paik MC, Rundek T, Elkind MS, Sacco RL (2011) Reweighting estimators for Cox regression with missing covariate data: analysis of insulin resistance and risk of stroke in the Northern Manhattan study. Stat Med 30:3328–3340
Schemper M, Smith TL (1996) A note on quantifying follow-up in studies of failure time. Control Clin Trials 17:343–346
Bartels SA, Vlug MS, Hollmann MW, Dijkgraaf MG, Ubbink DT, Cense HA, van Wagensveld BA, Engel AF, Gerhards MF, Bemelman WA (2014) Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study). Br J Surg 101:1153–1159
Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Hensley BJ, Noyes K, Monson JR, Fleming FJ (2015) Missed opportunity: laparoscopic colorectal resection is associated with lower incidence of small bowel obstruction compared to an open approach. Ann Surg. doi:10.1097/SLA.0000000000001389
Angenete E, Jacobsson A, Gellerstedt M, Haglind E (2012) Effect of laparoscopy on the risk of small-bowel obstruction: a population-based register study. Arch Surg 147:359–365
Murray BW, Cipher DJ, Pham T, Anthony T (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202:558–560
Jia WP, Lu JX, Xiang KS, Bao YQ, Lu HJ, Chen L (2003) Prediction of abdominal visceral obesity from body mass index, waist circumference and waist-hip ratio in Chinese adults: receiver operating characteristic curves analysis. Biomed Environ Sci 16:206–211
Hellebrekers BW, Kooistra T (2011) Pathogenesis of postoperative adhesion formation. Br J Surg 98:1503–1516
Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480
Kossi J, Salminen P, Rantala A, Laato M (2003) Population-based study of the surgical workload and economic impact of bowel obstruction caused by postoperative adhesions. Br J Surg 90:1441–1444
Menzies D, Ellis H (1990) Intestinal obstruction from adhesions: how big is the problem? Ann R Coll Surg Engl 72:60–63
Dowson HM, Bong JJ, Lovell DP, Worthington TR, Karanjia ND, Rockall TA (2008) Reduced adhesion formation following laparoscopic versus open colorectal surgery. Br J Surg 95:909–914
Tirumani H, Vassa R, Fasih N, Ojili V (2014) Small bowel obstruction in the emergency department: MDCT features of common and uncommon causes. Clin Imaging 38:580–588
Miller G, Boman J, Shrier I, Gordon PH (2000) Etiology of small bowel obstruction. Am J Surg 180:33–36
Masoomi H, Moghadamyeghaneh Z, Mills S, Carmichael JC, Pigazzi A, Stamos MJ (2015) Risk factors for conversion of laparoscopic colorectal surgery to open surgery: does conversion worsen outcome? World J Surg 39:1240–1247
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Drs. Kristian K. Jensen, Peter Andersen, Rune Erichsen, Thomas Scheike, Lene H. Iversen and Peter-Martin Krarup have no conflicts of interest or financial ties to disclose.
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Jensen, K.K., Andersen, P., Erichsen, R. et al. Decreased risk of surgery for small bowel obstruction after laparoscopic colon cancer surgery compared with open surgery: a nationwide cohort study. Surg Endosc 30, 5572–5582 (2016). https://doi.org/10.1007/s00464-016-4930-x
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DOI: https://doi.org/10.1007/s00464-016-4930-x