Analysis of laparoscopic colorectal surgery in high-risk patients

The aim of this retrospective study is to examine the feasibility and safety of laparoscopic colorectal resection for colorectal malignancies to determine "high-risk" patients. In our classification, 3 minor criteria including patients over 70 years of age, body mass index over 30 m/kg, and cigarette smoking and 5 major criteria including cardiac, pulmonary, renal, liver disease, and diabetes mellitus were selected to determine a high-risk group. Patients carrying 1 minor and 1 major criteria were classified as the high-risk group. Concerning patients and operations, hemodynamic values (mean arterial systolic and diastolic pressures and heart rates), oxygen saturations, end-expiratory carbon dioxide levels, respiratory mechanics (dynamic compliance, peak inspiratory pressure, airway resistance) were analyzed. Cardiovascular system (myocardial infarction, arrhythmia, hypertension), pulmonary system (respiratory insufficiency), digestive system (anastomotic leak, fistula, and paralytic ileus), fever, thrombophlebitis, urinary infections, wound infections, and central nervous system (delirium and cerebrovascular accident) were also investigated. A total number of 85 high-risk patients were included in the study. Gastrointestinal leaks in 2.3%, fistula in 1.1%, ileus in 3.5%, postoperative bleeding in 2.3%, postoperative fever in 5.8%, wound infection in 5.8%, and cerebrovascular accidents in 1.1% of patients were detected. The lowest values of hemodynamic and respiratory mechanics were observed at the induction of pneumoperitoneum and in this period the compliance and mean arterial pressure were determined to be 36+/-14 mm Hg and 84+/-14 mm Hg, respectively. No mortalities occurred. In experienced hands, laparoscopic colorectal resection can be performed safely for "high-risk" surgical patients.