title: The impact of adhesions on operations and postoperative recovery in colon cancer surgery.
abstract: BACKGROUND
  Many surgeons assume that adhesions encountered during surgery negatively influence surgical outcomes. This article attempts to assess the role adhesions have on outcomes of colon cancer surgery.
  
  
  METHODS
  Records of 1,071 consecutive patients operated for colonic adenocarcinoma (2004-2011) were reviewed. Patients were assigned to 3 groups: no adhesions, any adhesions, or dense adhesions. Multivariate regression assessed the association between adhesions and the duration of surgery and stay as well as laparoscopic conversion and complication rates.
  
  
  RESULTS
  Adhesions were encountered in 329 (30.7%) patients; 138 (12.8%) had dense adhesions. After correction for age and comorbidities, having adhesions was associated with longer surgeries (P < .001), longer hospital stays (P = .029), a borderline significantly higher conversion rate (P = .058), and a delayed return of bowel function (P = .037). Dense adhesions had stronger associations with surgical duration (P < .001), stay duration (P < .001), and conversion (P < .001).
  
  
  CONCLUSIONS
  Abdominal adhesions independently put patients at risk for a longer and more complicated perioperative stay after colon cancer surgery.
authors.affiliation: Division of General Surgery and Gastrointestinal Surgery, Harvard Medical School/Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Ramzi
authors.initials: R
authors.lastname: Amri
authors.forename: Hannah C
authors.initials: HC
authors.lastname: den Boon
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Bordeianou
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D003110:Colonic Neoplasms / Q000601:surgery*; D015897:Comorbidity; D061887:Conversion to Open Surgery / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000150:complications*; D016896:Treatment Outcome
keywords: Colon cancer; Complications; Intra-abdominal adhesions; Stay duration; Surgery duration