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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
Colorectal resection in emergency general surgery: An EAST multicenter trial.
Brittany O Aicher1, Matthew C Hernandez, Alejandro Betancourt-Ramirez
1From the R Adams Cowley Shock Trauma Center, Department of Surgery, University of Maryland Medical Center (B.O.A., L.O.M., J.K., B.B.R.), Baltimore, Maryland; Department of Surgery, Mayo Clinic (M.C.H., M.D.Z.), Rochester, Minnesota; Department of Surgery, Southside Hospital, Northwell Health (A.B.R., M.D.G.), Bay Shore, NY; Department of Surgery, UCHealth Memorial Hospital Central Trauma Center (T.J.S., H.H.), Colorado Springs, Colorado; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital (N.K., H.M.A.K.), Boston, Massachusetts; Department of Surgery, West Virginia University Medicine (A.W., D.G.), Morgantown, West Virginia; Department of Surgery, Robert Wood Johnson University Hospital (M.S., G.P.), New Brunswick, NJ; Department of Surgery, University of Southern California (G.C., K.M.), Los Angeles, California; Department of Surgery, Marshfield Clinic (D.C.C., L.M.C.), Marshfield, Wisconsin; Department of Surgery, Northwestern Memorial Hospital (B.S., J.P.), Chicago, Illinois; Department of Surgery, Loma Linda University Medical Center (U.J.S., R.D.C.), Loma Linda, CA; Dewitt Daughtry Family Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital (G.V., D.D.Y.), Miami, Florida; Department of Surgery, Methodist Dallas Medical Center (V.A., M.S.T.) Dallas, Texas; Department of Surgery, University of Texas Southwestern Medical Center and Parkland Hospital (M.P., L.D.), Dallas, Texas; Department of Surgery, Reading Hospital (A.M., A.W.O.), West Reading, Pennsylvania; Cooper University Health Care (J.L.S.R., N.B.), Camden, NJ; Department of Surgery, University of Colorado (O.F., C.G.V.), Denver, Colorado; George Washington University (C.H., J.M.E), Washington, District of Columbia; Department of Surgery, University of California, Irvine (S.G., J.N.), Irvine, California; Department of Surgery, Tufts University (K.J., N.B), Boston, Massachusetts; and Department of Surgery, Medical City Plano (V. P., M.M.C.), Plano, Texas.
In emergency colorectal surgery, stoma creation (STM) in sicker patients was linked to higher mortality and complications. However, after adjusting for clinical factors, the method of colon management did not significantly impact outcomes.
Area of Science:
- Colorectal Surgery
- Surgical Outcomes
- Emergency Medicine
Background:
- Limited evidence exists comparing stoma creation (STM) versus anastomosis after urgent or emergent colorectal resection.
- This study addresses the gap by examining outcomes in emergency general surgery patients undergoing colorectal resection.
Purpose of the Study:
- To compare outcomes between stoma creation and anastomosis in patients undergoing urgent or emergent colorectal resection.
- To identify risk factors for surgical complications and mortality in this patient population.
Main Methods:
- Prospective observational multicenter study involving 439 patients across 21 centers.
- Data collected included preoperative, intraoperative, and postoperative variables.
- Statistical analyses included chi-squared tests, Mann-Whitney U tests, and multivariable logistic regression.
Main Results:
- Stoma creation patients were older, had higher comorbidity indices, and presented with more severe illness (e.g., intubation, vasopressor use, fecal contamination).
- Overall mortality was 13%, with significantly higher rates in the stoma group (18% vs. 8%).
- Surgical complications were also more frequent in the stoma group (35% vs. 25%).
Conclusions:
- A tendency exists to perform stoma creation in acutely ill patients, associated with higher morbidity and mortality.
- Independent predictors of mortality included Charlson Comorbidity Index, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion.
- After adjusting for clinical factors, the method of colon management (stoma vs. anastomosis) was not significantly associated with surgical complications or mortality.
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