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Clinical Application of Single-Surgeon, Three-Port, Laparoscopic Resection for Colorectal Cancer with Natural Orifice Specimen Extraction
Published on: March 24, 2023
The minimally invasive approach is associated with reduced surgical site infections in obese patients undergoing
R T Pasam1, I O Esemuede2, S A Lee-Kong2
1Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Ave, 7 South Knuckle, New York, NY, 10032, USA. prteja2389@gmail.com.
Background:
While laparoscopic colorectal resection may be underused in technically challenging circumstances, the minimally invasive approach may in fact maximally benefit patients at the greatest risk of complications. Obesity and proctectomy pose particular technical challenges during laparoscopic resection and are also associated with the greatest risks of complications, especially surgical site infections (SSIs). We evaluated the role of laparoscopy in minimizing SSI in such patients.
Methods:
From the American College of Surgeons-National Surgical Quality Improvement Program database, outcomes for obese [body mass index (BMI) ≥ 30 kg/m(2)] and non-obese (BMI < 30 kg/m(2)) patients undergoing colectomy or proctectomy between 2006 and 2011 by the laparoscopic (laparoscopic colectomy, laparoscopic proctectomy) or open (open colectomy, open proctectomy) approaches were compared. A univariate analysis was used to determine the influence of laparoscopic surgery within each group on SSI, and a multivariate analysis evaluated the influence of laparoscopy on SSI for obese patients undergoing proctectomy.
Results:
OC patients were more likely than OP, LC, and LP, respectively, to undergo emergency operation and have an American Society of Anesthesiologists (ASA) score of 3-5. Overall SSI rates after OC, OP, LC, and LP were 15.2, 17.6, 8.6, and 10.1 %, respectively (p < 0.001), and for obese patients, the rates were 18.7, 22.3, 10.7, and 13.3 % (p < 0.001). On univariate analysis, open surgery, obesity, proctectomy, younger age, race, steroid use, diabetes, chronic obstructive pulmonary disease, prior wound infection, transfusion history, previous operation within 30 days, coronary artery or vascular disease, ASA class 3-5, tobacco use, resident involvement, male gender, albumin <3.5 g/dL, and emergent operation were associated with a higher risk of SSI. Laparoscopy reduced the risk of SSI by at least 35 % across all BMI classes and procedures, an effect that persisted on multivariate analysis even in obese patients undergoing proctectomy.
Conclusions:
In colorectal surgery, an already high-risk outlier for SSI, obesity and proctectomy are associated with the highest risk of SSI. Despite the particular technical challenges of laparoscopy in these circumstances, the minimally invasive approach attenuates the risk of SSI in these high-risk patients and thus should be strongly considered during treatment planning.
Insights
Laparoscopic colorectal surgery significantly reduces surgical site infections (SSIs), especially in obese patients and those undergoing proctectomy. This minimally invasive approach is recommended for high-risk patients to improve outcomes.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Surgical Site Infections
Background:
- Obesity and proctectomy increase complication risks, particularly surgical site infections (SSIs), in colorectal surgery.
- Laparoscopic colorectal resection may be underutilized in complex cases despite potential benefits for high-risk patients.
Purpose of the Study:
- To evaluate the effectiveness of laparoscopy in minimizing SSIs in obese patients and those undergoing proctectomy.
- To compare SSI rates between laparoscopic and open approaches in colorectal surgery for different patient groups.
Main Methods:
- Analysis of the American College of Surgeons-National Surgical Quality Improvement Program database (2006-2011).
- Comparison of outcomes for obese (BMI ≥ 30 kg/m²) and non-obese patients undergoing colectomy or proctectomy via laparoscopic or open surgery.
- Univariate and multivariate analyses to assess the influence of laparoscopy on SSI rates, particularly in obese patients undergoing proctectomy.
Main Results:
- Overall SSI rates were lower for laparoscopic colectomy (LC) and laparoscopic proctectomy (LP) (8.6% and 10.1%) compared to open colectomy (OC) and open proctectomy (OP) (15.2% and 17.6%).
- In obese patients, SSI rates were 10.7% for LC and 13.3% for LP, versus 18.7% for OC and 22.3% for OP.
- Laparoscopy reduced SSI risk by at least 35% across all BMI classes and procedures, a finding consistent in multivariate analysis for obese patients undergoing proctectomy.
Conclusions:
- Obesity and proctectomy are significant risk factors for SSIs in colorectal surgery.
- Laparoscopic colorectal surgery effectively reduces SSI risk in high-risk patients, including those who are obese or undergoing proctectomy.
- The benefits of laparoscopy in mitigating SSI risk strongly support its consideration in treatment planning for these challenging cases.
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