腹部手术前腹部手术对结直肠癌腹腔镜手术疗效的影响——以756例患者为对照研究

腹部手术前腹部手术对结直肠癌腹腔镜手术疗效的影响——以756例患者为对照研究
Impact of previous abdominal surgery on the outcome of laparoscopic resection for colorectal cancer- a case-control study in 756 patients

Abstract
BACKGROUND:
A history of previous abdominal surgery (PAS) may increase the complexity of laparoscopic colorectal surgery. The aim of this study was to investigate the impact of PAS on the outcomes of laparoscopic colorectal resection for colorectal cancer.

METHODS:
A total of 378 colorectal cancer patients (group A) with a history of PAS were 1:1 matched to 378 controls (group B) without PAS from our prospective laparoscopic colorectal surgery database. The two groups were matched for age, gender, body mass index, American Society of Anesthesiology score, tumor location, type of surgical procedure, and tumor stage.

RESULTS:
Patients in the two groups were well balanced with respect to baseline demographic and clinical characteristics. Group A was associated with significantly longer median operating time (220 versus 200 min; P = 0.002). Conversion rate in group A (63/378, 16.67%) was almost twice as high as that in group B (36/378, 9.55%; P = 0.004). Conversions caused by adhesion were more common in patients with a history of PAS (55.56% [35/63] versus 27.78% [10/36], P = 0.008). Postoperative recovery time, length of postoperative hospital stay, perioperative mortality and morbidity rate, lymph nodes harvested, circumferential resection margin positive rate, 3-y disease-free survival, and overall survival rate were not significantly different between the two groups.

CONCLUSIONS:
Laparoscopic colorectal surgery for colorectal cancer patients with PAS is time consuming, but the incidence of a successfully completed laparoscopic colorectal resection remains high, and the short- and long-term outcomes are not affected by PAS.

KEYWORDS:
Colorectal cancer; Conversion; Laparoscopic colorectal resection; Morbidity; Mortality; Previous abdominal surgery

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