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01-12-2011

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

Authors: Johnna Schölin, Mark Buunen, Wim Hop, Jaap Bonjer, Bo Anderberg, Miguel Cuesta, Salvadora Delgado, Ainitze Ibarzabal, Marie-Louise Ivarsson, Martin Janson, Antonio Lacy, Johan Lange, Lars Påhlman, Stefan Skullman, Eva Haglind

Published in: Surgical Endoscopy | Issue 12/2011

Abstract

Background

Postoperative bowel obstruction caused by intra-abdominal adhesions occurs after all types of abdominal surgery. It has been suggested that the laparoscopic technique should reduce the risk for adhesion formation and thus for postoperative bowel obstruction. This study was designed to compare the incidence of bowel obstruction in a randomized trial where laparoscopic and open resection for colon cancer was compared.

Methods

A retrospective analysis was performed, collecting data of episodes of bowel obstruction with or without surgery. Only episodes treated in the hospital where the index surgery took place were included. Data for 786 patients were collected for the 5-year period after cancer surgery.

Results

Baseline characteristics for the evaluated laparoscopic (n = 383) and open (n = 403) groups were comparable. The cumulative obstruction percentages at 5 years for the open and laparoscopic groups were 6.5 and 5.1% respectively and did not significantly differ from each other. Tumor stage seemed to influence the risk for bowel obstruction: 2.8% in stage I, 6.6% in stage II, and 7% in stage III, but the differences were not significant.

Conclusions

This analysis does not support the hypothesis that laparoscopy leads to fewer episodes of bowel obstruction compared with open surgery.

Menzies D, Ellis H (1990) Intestinal obstruction from adhesions—How big is the problem? Ann R Coll Surg Engl 72:60–63PubMed

Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O’Brien F, Buchan S, Crowe AM (1999) Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 353:1476–1480PubMedCrossRef

Chou NH, Mok KT, Wang BW, Chang HT, Hsu PI (2003) Risk factors of mortality after surgical treatment of intestinal obstruction in patients having prior laparotomy for non-malignancy. J Chin Med Assoc 66:741–746PubMed

Parker MC, Wilson MS, van Goor H, Moran BJ, Jeekel J, Duron JJ, Menzies D, Wexner SD, Ellis H (2007) Adhesions and colorectal surgery—call for action. Colorectal Dis 9(Suppl 2):66–72PubMedCrossRef

Parker MC, Wilson MS, Menzies D, Sunderland G, Thompson JN, Clark DN, Knight AD, Crowe AM (2004) Colorectal surgery: the risk and burden of adhesion-related complications. Colorectal Dis 6:506–511PubMedCrossRef

Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM (2005) The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis 7:551–558PubMedCrossRef

Milad MP, Escobar JC, Sanders W (2007) Partial small bowel obstruction and ileus following gynecologic laparoscopy. J Minim Invasive Gynecol 14:64–67PubMedCrossRef

Tsao KJ, St Peter SD, Valusek PA, Keckler SJ, Sharp S, Holcomb GW III, Snyder CL, Ostlie DJ (2007) Adhesive small bowel obstruction after appendectomy in children: comparison between the laparoscopic and open approach. J Pediatr Surg 42:939–942 (discussion 942)PubMedCrossRef

Rosin D, Zmora O, Hoffman A, Khaikin M, Bar Zakai B, Munz Y, Shabtai M, Ayalon A (2007) Low incidence of adhesion-related bowel obstruction after laparoscopic colorectal surgery. J Laparoendosc Adv Surg Tech A 17:604–607PubMedCrossRef

10.

Bergstrom M, Falk P, Park PO, Holmdahl L (2008) Peritoneal and systemic pH during pneumoperitoneum with CO₂ and helium in a pig model. Surg Endosc 22:359–364PubMedCrossRef

11.

Cainzos M, Rodriguez-Segade F, Martinez-Castro J, Prieto D, Becker MR, Aneiros F, Cortes J (2006) Intra-abdominal adhesions after open and laparoscopic cholecystectomy: an experimental model. J Laparoendosc Adv Surg Tech A 16:108–112PubMedCrossRef

12.

Lower AM, Hawthorn RJ, Clark D, Boyd JH, Finlayson AR, Knight AD, Crowe AM (2004) Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24046 patients. Hum Reprod 19:1877–1885PubMedCrossRef

13.

Jacobs M, Verdeja JC, Goldstein HS (1991) Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1:144–150PubMed

14.

Delgado S, Lacy AM, Filella X, Castells A, Garcia-Valdecasas JC, Pique JM, Momblan D, Visa J (2001) Acute phase response in laparoscopic and open colectomy in colon cancer: randomized study. Dis Colon Rectum 44:638–646PubMedCrossRef

15.

Hazebroek EJ (2002) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16:949–953PubMedCrossRef

16.

Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229PubMedCrossRef

17.

Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

18.

Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726PubMedCrossRef

19.

Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484PubMedCrossRef

20.

Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRef

21.

Buunen M, Veldkamp R, Hop WC, Kuhry E, Jeekel J, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52PubMedCrossRef

22.

Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Haglind E, Pahlman L (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303PubMedCrossRef

23.

Janson M, Bjorholt I, Carlsson P, Haglind E, Henriksson M, Lindholm E, Anderberg B (2004) Randomized clinical trial of the costs of open and laparoscopic surgery for colonic cancer. Br J Surg 91:409–417PubMedCrossRef

24.

Janson M, Lindholm E, Anderberg B, Haglind E (2007) Randomized trial of health-related quality of life after open and laparoscopic surgery for colon cancer. Surg Endosc 21:747–753PubMedCrossRef

25.

Janson M, Edlund G, Kressner U, Lindholm E, Pahlman L, Skullman S, Anderberg B, Haglind E (2009) Analysis of patient selection and external validity in the Swedish contribution to the COLOR trial. Surg Endosc 23:1764–1769PubMedCrossRef

26.

Kuhry E, Bonjer HJ, Haglind E, Hop WC, Veldkamp R, Cuesta MA, Jeekel J, Pahlman L, Morino M, Lacy A, Delgado S (2005) Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer. Surg Endosc 19:687–692PubMedCrossRef

27.

Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC, Parker MC, Guillou PJ (2010) Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. Br J Surg 97:70–78PubMedCrossRef

Title: Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial
Authors: Johnna Schölin
Mark Buunen
Wim Hop
Jaap Bonjer
Bo Anderberg
Miguel Cuesta
Salvadora Delgado
Ainitze Ibarzabal
Marie-Louise Ivarsson
Martin Janson
Antonio Lacy
Johan Lange
Lars Påhlman
Stefan Skullman
Eva Haglind
Publication date: 01-12-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 12/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1782-2

At a glance: The STEP trials

Springer Medicine

Bowel obstruction after laparoscopic and open colon resection for cancer: Results of 5 years of follow-up in a randomized trial

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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