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Published on: March 24, 2023
Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome
Marco Braga1, Andrea Vignali, Luca Gianotti
1Department of Surgery, San Raffaele University, Milan Italy. braga.marco@hsr.it
Insights
Laparoscopic colorectal surgery significantly reduces 30-day postoperative morbidity compared to open surgery. This minimally invasive approach also better preserves immune function and gut oxygen levels, leading to improved patient recovery.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Surgery
- Immunometabolism
Background:
- Limited evidence exists on the immunometabolic effects of laparoscopic colorectal surgery.
- Further randomized trials are needed to establish laparoscopy's superiority.
Purpose of the Study:
- To compare 30-day postoperative morbidity between laparoscopic and open colorectal surgery.
- To evaluate lymphocyte proliferation and gut oxygen tension as surrogate endpoints.
Main Methods:
- 269 patients randomized to laparoscopic (n=136) or open (n=133) colorectal resection.
- Postoperative complications were registered by independent staff.
- Lymphocyte proliferation and intraoperative gut oxygen tension were measured.
Main Results:
- Laparoscopic group had 20.6% morbidity vs. 38.3% in the open group.
- Fewer infections and shorter hospital stays in the laparoscopic group.
- Improved lymphocyte proliferation and higher gut oxygen tension with laparoscopy.
Conclusions:
- Laparoscopic colorectal surgery significantly reduces postoperative morbidity.
- Laparoscopy preserves immune function and gut oxygen tension better than open surgery.
Objective:
The primary endpoint was to compare the impact of laparoscopic and open colorectal surgery on 30-day postoperative morbidity. Lymphocyte proliferation to mitogens and gut oxygen tension were surrogate endpoints.
Summary Background Data:
Evidence-based proof of the effect of laparoscopic colorectal surgery on immunometabolic response and clinically relevant outcome variables is scanty. Further randomized trials are desirable before proposing laparoscopy as a superior technique.
Methods:
Two hundred sixty-nine patients with colorectal disease were randomly assigned to laparoscopic (n = 136) or open (n = 133) colorectal resection. Four trained members of the surgical staff who were not involved in the study registered postoperative complications. Lymphocyte proliferation to Candida albicans and phytohemagglutinin was evaluated before and 3 and 15 days after surgery. Operative gut oxygen tension was monitored continuously by a polarographic microprobe.
Results:
In the laparoscopic group the conversion rate was 5.1%. The overall morbidity rate was 20.6% in the laparoscopic group and 38.3% in the open group. Postoperative infections occurred in 15 of the 136 patients in the laparoscopic group and 31 of the 133 patients in the open group. The mean length of hospital stay was 10.4 +/- 2.9 days in the laparoscopic group and 12.5 +/- 4.1 days in the open group. On postoperative day 3, lymphocyte proliferation was impaired in both groups. Fifteen days after surgery, the proliferation index returned to baseline values only in the laparoscopic group. Intraoperative gut oxygen tension was higher in the laparoscopic than in the open group.
Conclusions:
Laparoscopic colorectal surgery resulted in a significant reduction of 30-day postoperative morbidity. Lymphocyte proliferation and gut oxygen tension were better preserved in the laparoscopic group than in the open group.
