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- Tiefenthal, M., et al.
(författare)
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Laparoscopic and open right-sided colonic resection in daily routine practice. A prospective multicentre study within an Enhanced Recovery After Surgery (ERAS) protocol
- 2016
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 18:2, s. 187-194
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Tidskriftsartikel (refereegranskat)abstract
- AimThe study compared the outcome of laparoscopic and open surgery in daily practice when performed in a strict Enhanced Recovery After Surgery (ERAS) environment. MethodTwo-hundred and ninety-two consecutive patients who received elective surgery, in three Swedish ERAS centres, for cancer or adenoma in the right colon in the period 1 January 2011 to 31 December 2012, were prospectively registered in a Web-based ERAS database. Peri-operative data were collected from the database and patient charts. The primary end-points included postoperative recovery and morbidity. The secondary objective was to identify preoperative variables that influenced the selection of patients for laparoscopic or open surgery. ResultsOne-hundred and twenty-three (42%) patients were selected for laparoscopic surgery. The overall preoperative ERAS-compliance rate was 87% and no significant difference was seen between the surgical techniques. In multivariate analysis, patients treated with laparoscopy had significantly earlier pain control (2.43.2days vs 4.2 +/- 5.9days; P=0.016) and a shorter length of hospital stay (LOS) (4days vs 6days; P=0.002) compared with open surgery. There was no significant difference in the complication rate [18.7% vs 21.3%; OR=1.0 (95% CI: 0.5-2.0)], the number of lymph nodes removed or the rate of R0 resection between laparoscopic and open surgery. Tumours selected for laparoscopy weregenerally smaller, had a lower T-stage and were predominantly situated in the caecum and the ascending colon compared with those of patients selected for open surgery. ConclusionThe use of laparoscopy in routine right-sided colectomy in an ERAS environment, with data on outcome corrected for selection bias, may result in faster recovery compared with open surgery.
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