title: The minimally invasive approach is associated with reduced perioperative thromboembolic and bleeding complications for patients receiving preoperative chronic oral anticoagulant therapy who undergo colorectal surgery.
abstract: BACKGROUND
  The data on the perioperative risk of both thromboembolism and hemorrhage for patients receiving chronic oral anticoagulation who undergo colorectal surgery are sparse. In addition, it is uncertain whether the use of the laparoscopic instead of open technique entails additional risk for these patients. This study aimed to evaluate surgical outcomes, with a particular focus on perioperative thromboembolic and bleeding complications for patients receiving chronic oral anticoagulation therapy who undergo open or laparoscopic colorectal resection.
  
  
  METHODS
  Patients undergoing colorectal resection between 1994 and 2011 on preoperative chronic oral anticoagulant therapy were included in the study. Patient demographics, characteristics, and perioperative outcomes, with particular emphasis on thromboembolism and bleeding risks, were evaluated comparing laparoscopic and open colectomy.
  
  
  RESULTS
  The study enrolled 261 patients receiving chronic anticoagulation therapy (102 laparoscopic colectomy vs 159 open colectomy patients). The patients had a mean age of 57.9 years and a mean body mass index (BMI) of 29.3 kg/m(2). The conversion rate was 8.8 % (n = 9) for laparoscopic operations. Laparoscopic and open cases had comparable BMIs and levels of preoperative hemoglobin. Anastomotic leak, postoperative hospital stay, and surgical-site infection rates were similar for the two groups. Although the laparoscopic group had a significantly greater mean age (p < 0.001) and American Society of Anesthesiology (ASA) score (p = 0.005), the rates for postoperative venous thromboembolism (24.5 vs 2.9 %; p < 0.001), urinary complications (6.9 vs 0 %; p = 0.008), and overall morbidity (44.7 vs 17.7 %; p < 0.001) were lower after laparoscopic surgery. Although the rates for intra- and postoperative blood transfusion were similar, the postoperative hemoglobin levels were significantly higher after laparoscopic surgery. One patient in the laparoscopic group died of sepsis on postoperative day 3.
  
  
  CONCLUSIONS
  For the patients receiving preoperative chronic anticoagulant therapy who underwent colorectal resection, the laparoscopic approach was associated with lower thromboembolic and hemorrhagic complications than open surgery.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Barlas
authors.initials: B
authors.lastname: Sulu
authors.forename: Erman
authors.initials: E
authors.lastname: Aytac
authors.forename: Luca
authors.initials: L
authors.lastname: Stocchi
authors.forename: Jon D
authors.initials: JD
authors.lastname: Vogel
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D003107:Colorectal Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000139:chemically induced* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants