Re-interventions following laparoscopic surgery for colorectal cancer: data from 818 individuals from the Dutch surgical colorectal audit.
BACKGROUND
The surgical procedure of choice for the resection of colorectal cancer has shifted in favor of laparoscopic surgery. Although increasing data prove advantages of elective laparoscopic surgery, less is known about the results in acute indications such as surgical re-interventions following colorectal resections. This study aims to assess the clinical benefits in recovery following laparoscopic re-interventions compared with open re-interventions following laparoscopic colorectal cancer surgery.


METHODS
We performed an analysis of data from the Dutch Surgical Colorectal Audit from January 2010 to December 2012. All patients requiring surgical re-intervention after initial laparoscopic colorectal surgery were analyzed.


RESULTS
Out of 27,448 patients, 11,856 underwent laparoscopic surgery. Following laparoscopic surgery, 159 patients (1.3%) had a laparoscopic re-intervention, and 659 patients (5.6%) had an open re-intervention. In a multivariable analysis adjusting for patients' demographics and risk factors, the length of hospital stay was 17 days (interquartile range, 11-16 days) for the laparoscopic group and 23 days (interquartile range, 14-37 days) for the open group (odds ratio [OR]=0.74; 95% confidence interval [CI], 0.65-0.84). In the laparoscopic group the intensive care unit admission rate was 39% compared with 66% in the open group. The 30-day mortality rate was 7 (4%) in the laparoscopic group compared with 89 (14%) in the open group (OR=0.31; 95% CI, 0.13-0.73).


CONCLUSIONS
Laparoscopic re-intervention following laparoscopic surgery for colorectal cancer is feasible in selected patients. Because of the unknown extent of selection bias, prospective studies are needed to define the exact position and benefits of laparoscopic re-interventions.
Department of Surgery, Jeroen Bosch Hospital , 's-Hertogenbosch, The Netherlands .
Sandra
S
Vennix
Olaf J
OJ
Bakker
Hubert A
HA
Prins
Daniel J
DJ
Lips
D000368:Aged; D054869:Clinical Audit; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome