Obese patients benefit from minimally invasive colorectal cancer surgery.
BACKGROUND
Minimally invasive surgery (MIS) for colorectal cancer offers improved short-term outcomes compared with open surgery. However, there is concern that MIS is more difficult in obese patients and may be associated with worse oncologic outcomes while failing to preserve short-term benefits. We hypothesized that obese patients undergoing surgery for colorectal cancer (CRC) would benefit from MIS.


METHODS
Retrospective database review.


RESULTS
Database review identified 155 obese patients undergoing resections for CRC from 2002-2009. Open cases accounted for 73% (N = 113) and MIS for 27% (N = 42). Conversion from MIS to open surgery occurred in 26% of cases. Obese patients had a nonsignificantly decreased rate of wound infection after MIS (21%) versus open surgery (28%, P < 0.645), while the incidence of other complications did not differ by surgical approach. The MIS cohort demonstrated faster return of bowel function and returned home a median of 2 days faster group than in the open surgery group (P < 0.003). From an oncologic standpoint, MIS was at least equivalent to open surgery as median number of lymph nodes extracted (20 versus 15, P < 0.073) and proportion of margin negative resections (97% versus 98%, P < 0.654) did not significantly differ between the two groups.


CONCLUSIONS
Minimally invasive surgery for CRC is safe and effective in obese patients since bowel function recovers rapidly, and hospital stay is significantly reduced while the quality of oncologic care is maintained.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77057, USA. cb131098@bcm.tmc.edu
Courtney J
CJ
Balentine
Christy
C
Marshall
Celia
C
Robinson
Jonathan
J
Wilks
Daniel
D
Anaya
Daniel
D
Albo
David H
DH
Berger
D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D015179:Colorectal Neoplasms / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014728:Veterans