title: Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study).
abstract: BACKGROUND
  Short-term advantages to laparoscopic surgery are well described. This study compared medium- to long-term outcomes of a randomized clinical trial comparing laparoscopic and open colonic resection for cancer.
  
  
  METHODS
  The case notes of patients included in the LAFA study (perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care) were reviewed 2-5 years after randomization for incisional hernia, adhesional small bowel obstruction (SBO), overall survival, cancer recurrence and quality of life (QoL). The laparoscopic and open groups were compared irrespective of fast-track or standard perioperative care.
  
  
  RESULTS
  Data on incisional hernias, SBO, survival and recurrence were available for 399 of 400 patients: 208 laparoscopic and 191 open resections. These outcomes were corrected for duration of follow-up. Median follow-up was 3·4 (i.q.r. 2·6-4·4) years. Multivariable regression analysis showed that open resection was a risk factor for incisional hernia (odds ratio (OR) 2·44, 95 per cent confidence interval (c.i.) 1·12 to 5·26; P = 0·022) and SBO (OR 3·70, 1·07 to 12·50; P = 0·039). There were no differences in overall survival (hazard ratio 1·10, 95 per cent c.i. 0·67 to 1·80; P = 0·730) or in cumulative incidence of recurrence (P = 0·514) between the laparoscopic and open groups. There were no measured differences in QoL in 281 respondents (P > 0·350 for all scales).
  
  
  CONCLUSIONS
  Laparoscopic colonic surgery led to fewer incisional hernia and adhesional SBO events.
  
  
  BACKGROUND
  NTR222 (http://www.trialregister.nl).
authors: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors: S A L
authors: SA
authors: Bartels
authors: M S
authors: MS
authors: Vlug
authors: M W
authors: MW
authors: Hollmann
authors: M G W
authors: MG
authors: Dijkgraaf
authors: D T
authors: DT
authors: Ubbink
authors: H A
authors: HA
authors: Cense
authors: B A
authors: BA
authors: van Wagensveld
authors: A F
authors: AF
authors: Engel
authors: M F
authors: MF
authors: Gerhards
authors: W A
authors: WA
authors: Bemelman
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000401:mortality; D007421:Intestine, Small; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D011788:Quality of Life