title: Non-surgical complications after laparoscopic and open surgery for colorectal cancer - A systematic review of randomised controlled trials.
abstract: BACKGROUND
  Cardiac and pulmonary complications account for a large part of postoperative mortality, especially in the growing number of elderly patients. This review studies the effect of laparoscopic surgery for colorectal cancer on short term non-surgical morbidity.
  
  
  METHODS
  A literature search was conducted to identify randomised trials on laparoscopic compared to open surgery for colorectal cancer with reported cardiac or pulmonary complications.
  
  
  RESULTS
  The search retrieved 3302 articles; 18 studies were included with a total of 6153 patients. Reported median or mean age varied from 56 years to 72 years. The percentage of included patients with ASA-scores ≥ 3 ranged from 7% to 38%. Morbidity was poorly defined. Overall reported incidence of postoperative cardiac complications was low for both laparoscopic and open colorectal resection (median 2%). There was a trend towards fewer cardiac complications following laparoscopic surgery (OR 0.66, 95% CI 0.41-1.06, p = 0.08), and this effect was most marked for laparoscopic colectomy (OR 0.28, 95% CI 0.11-0.71, p = 0.007). Incidence of pulmonary complications ranged from 0 to 11% and no benefit was found for laparoscopic surgery, although a possible trend was seen in favour of laparoscopic colectomy (OR 0.78, 95% CI 0.53-1.13, p = 0.19). Overall morbidity rates varied from 11% to 69% with a median of 33%.
  
  
  CONCLUSIONS
  Although morbidity was poorly defined, for laparoscopic colectomies, significantly less cardiac complications occurred compared with open surgery and a trend towards less pulmonary complications was observed. Subgroup analysis from two RCTs suggests that elderly patients benefit most from a laparoscopic approach based on overall morbidity rates.
authors.affiliation: Dept. of Surgery, Diakonessenhuis, Utrecht, The Netherlands. Electronic address: aschiphorst@diakhuis.nl.
authors.forename: A H W
authors.initials: AH
authors.lastname: Schiphorst
authors.affiliation: Dept. of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: N M
authors.initials: NM
authors.lastname: Verweij
authors.affiliation: Dept. of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Pronk
authors.affiliation: Dept. of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: I H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.affiliation: Dept. of Geriatric Medicine, Diakonessenhuis, Utrecht and Zeist, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Hamaker
mesh_terms: D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008171:Lung Diseases / Q000453:epidemiology*; D009422:Nervous System Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D014652:Vascular Diseases / Q000453:epidemiology
keywords: Adverse events; Cardiopulmonary morbidity; Colectomy; Colorectal cancer; Complications; Laparoscopy; Non-surgical complications