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Erschienen in: Surgical Endoscopy 10/2017

09.03.2017

Laparoscopic colectomy in obese patients: a comparison of laparoscopic and hand-assisted laparoscopic techniques

verfasst von: Douglas M. Overbey, Michelle L. Cowan, Patrick W. Hosokawa, Brandon C. Chapman, Jon D. Vogel

Erschienen in: Surgical Endoscopy | Ausgabe 10/2017

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Abstract

Background

Recent American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP)-based evidence indicates that laparoscopic (LAP) colectomy results in improved outcomes compared to hand-assisted laparoscopic (HAL) colectomy in the general population. Previous comparative studies demonstrated that the HAL technique offers distinct advantages for obese patients. The aim of this study was to perform comparative analyses of HAL and LAP colectomy and low anterior resection (LAR) in obese patients.

Methods

The ACS-NSQIP public use file and targeted colectomy dataset, 2012-2014, were utilized for patients undergoing colectomy and LAR. Only obese patients (BMI > 30) and laparoscopic or hand-assisted operations were included. Patient, operation, and outcome variables were compared in two separate cohorts: colectomy and LAR. Bivariate analysis compared the approaches, followed by multivariable regression.

Results

Of 9610 obese patients included, HAL and LAP colectomy were performed in 3126 and 3793 patients and LAR in 1431 and 1260 patients, respectively. In comparison to LAP colectomy, HAL colectomy patients had increased comorbidities including class 2 and 3 obesity. HAL colectomy was associated with higher overall morbidity (20 vs. 16%, p < 0.001), infectious complications (10.2 vs. 7.7%, p < 0.001), anastomotic leaks (3.0 vs. 2.2%, p = 0.03), and ileus (11 vs. 8%, p < 0.001). Multivariate analysis indicated that overall morbidity (OR 1.27, 95% CI 1.11–1.44), infectious complications (OR 1.35, 95% CI 1.14–1.59), and ileus (OR 1.33, 95% CI 1.12–1.57) were each increased in the HAL colectomy cohort but not different for HAL and LAP LAR.

Conclusions

In comparison to LAP colectomy, the HAL technique is used more often in obese patients with an increased operative risk profile. While inherent bias and unmeasured variables limit the analysis, the available data indicate that the HAL technique is associated with increased perioperative morbidity. Alternatively, HAL and LAP LAR are performed in obese patients with a similar risk profile and result in similar postoperative outcomes.
Literatur
1.
Zurück zum Zitat The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef
2.
Zurück zum Zitat Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229CrossRefPubMed Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229CrossRefPubMed
3.
Zurück zum Zitat Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3:CD003145 Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3:CD003145
4.
Zurück zum Zitat HALS Study Group (2000) Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease. Surg Endosc 14:896–901CrossRef HALS Study Group (2000) Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease. Surg Endosc 14:896–901CrossRef
5.
6.
Zurück zum Zitat Nakajima K, Lee SW, Cocilovo C, Foglia C, Sonoda T, Milsom JW (2004) Laparoscopic total colectomy: hand-assisted vs standard technique. Surg Endosc 18:582–586CrossRefPubMed Nakajima K, Lee SW, Cocilovo C, Foglia C, Sonoda T, Milsom JW (2004) Laparoscopic total colectomy: hand-assisted vs standard technique. Surg Endosc 18:582–586CrossRefPubMed
7.
Zurück zum Zitat Lee SW, Yoo J, Dujovny N, Sonoda T, Milsom JW (2006) Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum 49:464–469CrossRefPubMed Lee SW, Yoo J, Dujovny N, Sonoda T, Milsom JW (2006) Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis. Dis Colon Rectum 49:464–469CrossRefPubMed
8.
Zurück zum Zitat Stein S, Whelan RL (2007) The controversy regarding hand-assisted colorectal resection. Surg Endosc 21:2123–2126CrossRefPubMed Stein S, Whelan RL (2007) The controversy regarding hand-assisted colorectal resection. Surg Endosc 21:2123–2126CrossRefPubMed
9.
Zurück zum Zitat Cima RR, Pendlimari R, Holubar SD, Pattana-Arun J, Larson DW, Dozois EJ, Wolff BG, Pemberton JH (2011) Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients. Dis Colon Rectum 54(9):1076–1081CrossRefPubMed Cima RR, Pendlimari R, Holubar SD, Pattana-Arun J, Larson DW, Dozois EJ, Wolff BG, Pemberton JH (2011) Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients. Dis Colon Rectum 54(9):1076–1081CrossRefPubMed
10.
Zurück zum Zitat Samalavicius NE, Gupta RK, Dulskas A, Kazanavicius D, Petrulis K, Lunevicius R (2013) Clinical outcomes of 103 hand-assisted laparoscopic surgeries for left-sided colon and rectal cancer: single institutional review. Ann Coloproctol 29(6):225–230CrossRefPubMedPubMedCentral Samalavicius NE, Gupta RK, Dulskas A, Kazanavicius D, Petrulis K, Lunevicius R (2013) Clinical outcomes of 103 hand-assisted laparoscopic surgeries for left-sided colon and rectal cancer: single institutional review. Ann Coloproctol 29(6):225–230CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Tajima T, Mukai M, Yamazaki M, Higami S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H (2014) Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for colorectal cancer: Interim results from a single institution. Oncol Lett 8(2):627–632PubMedPubMedCentral Tajima T, Mukai M, Yamazaki M, Higami S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda S, Makuuchi H (2014) Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for colorectal cancer: Interim results from a single institution. Oncol Lett 8(2):627–632PubMedPubMedCentral
12.
Zurück zum Zitat Tajima T, Mukai M, Noguchi W, Higami S, Uda S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda D, Makuuchi H (2015) Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for rectal cancer: Interim results from a single center. Mol. Clin Oncol 3(3):533–538CrossRefPubMedPubMedCentral Tajima T, Mukai M, Noguchi W, Higami S, Uda S, Yamamoto S, Hasegawa S, Nomura E, Sadahiro S, Yasuda D, Makuuchi H (2015) Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for rectal cancer: Interim results from a single center. Mol. Clin Oncol 3(3):533–538CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Targarona EM, Gracia E, Garriga J, Martinez-Bru C, Cortes M, Boluda R, Lerma L, Trias M (2002) Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy. Surg Endosc 16:234–239CrossRefPubMed Targarona EM, Gracia E, Garriga J, Martinez-Bru C, Cortes M, Boluda R, Lerma L, Trias M (2002) Prospective randomized trial comparing conventional laparoscopic colectomy with hand-assisted laparoscopic colectomy. Surg Endosc 16:234–239CrossRefPubMed
14.
Zurück zum Zitat Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL (2008) Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 51:818–828CrossRefPubMed Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL (2008) Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 51:818–828CrossRefPubMed
15.
Zurück zum Zitat Hassan I, You YN, Cima RR, Larson DW, Dozois EJ, Barnes SA, Pemberton JH (2008) Hand-assisted versus laparoscopic-assisted colorectal surgery: practice patterns and clinical outcomes in a minimally-invasive colorectal practice. Surg Endosc 22:739–743CrossRefPubMed Hassan I, You YN, Cima RR, Larson DW, Dozois EJ, Barnes SA, Pemberton JH (2008) Hand-assisted versus laparoscopic-assisted colorectal surgery: practice patterns and clinical outcomes in a minimally-invasive colorectal practice. Surg Endosc 22:739–743CrossRefPubMed
16.
Zurück zum Zitat Ozturk E, Kiran RP, Geisler DP, Hull TL, Vogel JD (2009) Hand-assisted laparoscopic colectomy: benefits of laparoscopic colectomy at no extra cost. J Am Coll Surg 209(2):242–247CrossRefPubMed Ozturk E, Kiran RP, Geisler DP, Hull TL, Vogel JD (2009) Hand-assisted laparoscopic colectomy: benefits of laparoscopic colectomy at no extra cost. J Am Coll Surg 209(2):242–247CrossRefPubMed
17.
Zurück zum Zitat Ozturk E, Kiran RP, Remzi F, Geisler D, Fazio V (2010) Hand-assisted laparoscopic surgery may be a useful tool for surgeons early in the learning curve performing total abdominal colectomy. Colorectal Dis 12(3):199–205CrossRefPubMed Ozturk E, Kiran RP, Remzi F, Geisler D, Fazio V (2010) Hand-assisted laparoscopic surgery may be a useful tool for surgeons early in the learning curve performing total abdominal colectomy. Colorectal Dis 12(3):199–205CrossRefPubMed
18.
Zurück zum Zitat Vogel JD, Lian L, Kalady MF, de Campos-Lobato LF, Alves-Ferreira PC, Remzi FH (2011) Hand-assisted laparoscopic right colectomy: how does it compare to conventional laparoscopy?. J Am Coll Surg 212(3):367–372CrossRefPubMed Vogel JD, Lian L, Kalady MF, de Campos-Lobato LF, Alves-Ferreira PC, Remzi FH (2011) Hand-assisted laparoscopic right colectomy: how does it compare to conventional laparoscopy?. J Am Coll Surg 212(3):367–372CrossRefPubMed
19.
Zurück zum Zitat Mooloo H, Haggar F, Coyle D, Hutton B, Duhaime S, Mamazza J, Poulin EC, Boushey RP, Grimshaw J (2010) Hand assisted laparoscopic surgery versus conventional laparoscopy for colorectal surgery (Review). Cochrane Database Syst Rev. 10 Mooloo H, Haggar F, Coyle D, Hutton B, Duhaime S, Mamazza J, Poulin EC, Boushey RP, Grimshaw J (2010) Hand assisted laparoscopic surgery versus conventional laparoscopy for colorectal surgery (Review). Cochrane Database Syst Rev. 10
20.
Zurück zum Zitat Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ (2015) Hand-assisted laparoscopic approach in colon surgery. J Gastrointest Surg 19(11):2045–2053CrossRefPubMed Moghadamyeghaneh Z, Carmichael JC, Mills S, Pigazzi A, Nguyen NT, Stamos MJ (2015) Hand-assisted laparoscopic approach in colon surgery. J Gastrointest Surg 19(11):2045–2053CrossRefPubMed
21.
Zurück zum Zitat Benlice C, Costedio M, Kessler H, Remzi FH, Gorgun E (2016) Comparison of straight vs hand-assisted laparoscopic colectomy: an assessment from the NSQIP procedure-targeted cohort. Am J Surg doi: 10.1016/j.amjsurg.2016.01.026 Benlice C, Costedio M, Kessler H, Remzi FH, Gorgun E (2016) Comparison of straight vs hand-assisted laparoscopic colectomy: an assessment from the NSQIP procedure-targeted cohort. Am J Surg doi: 10.​1016/​j.​amjsurg.​2016.​01.​026
22.
Zurück zum Zitat Myers EA, Feingold DL, Arnell TD, Njoh L, Cekic V, Jang JH, Naffouje S, Whelan RL (2014) The rate for the use of hand-assisted laparoscopic methods is directly proportional to body mass index. Surg Endosc 28:108–115CrossRefPubMed Myers EA, Feingold DL, Arnell TD, Njoh L, Cekic V, Jang JH, Naffouje S, Whelan RL (2014) The rate for the use of hand-assisted laparoscopic methods is directly proportional to body mass index. Surg Endosc 28:108–115CrossRefPubMed
23.
Zurück zum Zitat Heneghan HM, Martin ST, Kiran RP, Khoury W, Stocchi L, Remzi FH, Vogel JD (2013) Laparoscopic Colorectal Surgery for Obese Patients: Decreased Conversions with the Hand-Assisted Technique. J Gastrointest Surg 17:548–554CrossRefPubMed Heneghan HM, Martin ST, Kiran RP, Khoury W, Stocchi L, Remzi FH, Vogel JD (2013) Laparoscopic Colorectal Surgery for Obese Patients: Decreased Conversions with the Hand-Assisted Technique. J Gastrointest Surg 17:548–554CrossRefPubMed
25.
Zurück zum Zitat Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, Chong V, Fabri PJ, Gibbs JO, Grover F, Hemmermeister K, Irvin G 3rd, McDonald G, Passaro E Jr, Phillips L, Scamman F, Spencer J, Stremple JF (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 228(4):491–507CrossRefPubMedPubMedCentral Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, Chong V, Fabri PJ, Gibbs JO, Grover F, Hemmermeister K, Irvin G 3rd, McDonald G, Passaro E Jr, Phillips L, Scamman F, Spencer J, Stremple JF (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 228(4):491–507CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Lange EO, Jensen CC, Melton GB, Madoff RD, Kwaan MR (2015) Relationship between model for end-stage liver disease score and 30-day outcomes for patients undergoing elective colorectal resections: an american college of surgeons-national surgical quality improvement program study. Dis Colon Rectum 58(5):494–501CrossRefPubMed Lange EO, Jensen CC, Melton GB, Madoff RD, Kwaan MR (2015) Relationship between model for end-stage liver disease score and 30-day outcomes for patients undergoing elective colorectal resections: an american college of surgeons-national surgical quality improvement program study. Dis Colon Rectum 58(5):494–501CrossRefPubMed
27.
Zurück zum Zitat Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X, Liu Y, Kraemer K, Meng X, Merkow R, Chow W, Matel B, Richards K, Hart AJ, Dimick JB, Hall BL (2013) Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. JACS 217 (2):336–346 Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X, Liu Y, Kraemer K, Meng X, Merkow R, Chow W, Matel B, Richards K, Hart AJ, Dimick JB, Hall BL (2013) Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. JACS 217 (2):336–346
29.
Zurück zum Zitat Guend H, Lee DY, Myers EA, Gandhi ND, Cekic V, Whelan RL (2015) Technique of last resort: characteristics of patients undergoing open surgery in the laparoscopic era. Surg Endosc 29(9):2763–2769CrossRefPubMed Guend H, Lee DY, Myers EA, Gandhi ND, Cekic V, Whelan RL (2015) Technique of last resort: characteristics of patients undergoing open surgery in the laparoscopic era. Surg Endosc 29(9):2763–2769CrossRefPubMed
30.
Zurück zum Zitat Tjandra JJ, Chan MK, Yeh CH (2008) Laparoscopic- vs. hand-assisted ultralow anterior resection: a prospective study. Dis Colon Rectum 51(1):26–31CrossRefPubMed Tjandra JJ, Chan MK, Yeh CH (2008) Laparoscopic- vs. hand-assisted ultralow anterior resection: a prospective study. Dis Colon Rectum 51(1):26–31CrossRefPubMed
31.
Zurück zum Zitat Pyo DH, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY, Chun HK (2016) A comparison of hand-assisted laparoscopic surgery and conventional laparoscopic surgery in rectal cancer: a propensity score analysis. Surg Endosc 30(6):2449–2456CrossRefPubMed Pyo DH, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY, Chun HK (2016) A comparison of hand-assisted laparoscopic surgery and conventional laparoscopic surgery in rectal cancer: a propensity score analysis. Surg Endosc 30(6):2449–2456CrossRefPubMed
32.
Zurück zum Zitat Kumara HMCS, Gaita DJ, Miyagaki H, Yan X, Herath SAC, Cekic V, Whelan RL (2014) Minimally invasive colorectal resection is associated with significantly elevated levels of plasma matrix metalloproteinase 3 (MMP-3) during the first month after surgery which may promote the growth of residual metastases. Surg Endosc 28:3322–3328CrossRef Kumara HMCS, Gaita DJ, Miyagaki H, Yan X, Herath SAC, Cekic V, Whelan RL (2014) Minimally invasive colorectal resection is associated with significantly elevated levels of plasma matrix metalloproteinase 3 (MMP-3) during the first month after surgery which may promote the growth of residual metastases. Surg Endosc 28:3322–3328CrossRef
33.
Zurück zum Zitat Bärlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19(6):757–766CrossRefPubMed Bärlehner E, Benhidjeb T, Anders S, Schicke B (2005) Laparoscopic resection for rectal cancer: outcomes in 194 patients and review of the literature. Surg Endosc 19(6):757–766CrossRefPubMed
34.
Zurück zum Zitat Köckerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein H, Reymond MA, Reck T, Konradt J, Bruch HP, Zornig C, Bärlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic colorectal surgery study group (LCSSG). Surg Endosc 13(7):639–644CrossRefPubMed Köckerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein H, Reymond MA, Reck T, Konradt J, Bruch HP, Zornig C, Bärlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W (1999) Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic colorectal surgery study group (LCSSG). Surg Endosc 13(7):639–644CrossRefPubMed
35.
Zurück zum Zitat Veyrie N, Ata T, Muscari F, Couchard AC, Msika S, Hay JM, Fingerhut A, Dziri C; French Associations for Surgical Research (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg. 205(6): 785–793.CrossRefPubMed Veyrie N, Ata T, Muscari F, Couchard AC, Msika S, Hay JM, Fingerhut A, Dziri C; French Associations for Surgical Research (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg. 205(6): 785–793.CrossRefPubMed
36.
Zurück zum Zitat Yamamoto S, Fujita S, Akasu T, Moriya Y (2004) A comparison of the complication rates between laparoscopic colectomy and laparoscopic low anterior resection. Surg Endosc 18(10):1447–1451CrossRefPubMed Yamamoto S, Fujita S, Akasu T, Moriya Y (2004) A comparison of the complication rates between laparoscopic colectomy and laparoscopic low anterior resection. Surg Endosc 18(10):1447–1451CrossRefPubMed
37.
Zurück zum Zitat Pendlimari R, Touzios JG, Azodo IA, Chua HK, Dozois EJ, Cima RR, Larson DW (2011) Short-term outcomes after elective minimally invasive colectomy for diverticulitis. Br J Surg 98(3):431–435CrossRefPubMed Pendlimari R, Touzios JG, Azodo IA, Chua HK, Dozois EJ, Cima RR, Larson DW (2011) Short-term outcomes after elective minimally invasive colectomy for diverticulitis. Br J Surg 98(3):431–435CrossRefPubMed
Metadaten
Titel
Laparoscopic colectomy in obese patients: a comparison of laparoscopic and hand-assisted laparoscopic techniques
verfasst von
Douglas M. Overbey
Michelle L. Cowan
Patrick W. Hosokawa
Brandon C. Chapman
Jon D. Vogel
Publikationsdatum
09.03.2017
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 10/2017
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5422-3

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