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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2016

01-02-2016

Outcomes for single-incision laparoscopic colectomy surgery in obese patients: a case-matched study

Authors: Deborah S. Keller, Sergio Ibarra, Juan Ramon Flores-Gonzalez, Oscar Moreno Ponte, Nisreen Madhoun, T. Bartley Pickron, Eric M. Haas

Published in: Surgical Endoscopy | Issue 2/2016

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Abstract

Background

Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS offers several patient-related benefits over multiport laparoscopy. However, its use in obese patients has been limited from concerns of technical difficulty, oncologic compromise, and higher complication and conversion rates. Our objective was to evaluate the feasibility and efficacy of SILS for colectomy in obese patients.

Methods

Review of a prospective database identified patients undergoing elective colectomy using SILS from 2009 to 2014. They were stratified into obese (BMI ≥ 30 kg/m2) and non-obese cohorts (BMI < 30 kg/m2) and then matched on patient characteristics, diagnosis, and operative procedure. Demographic and perioperative outcome data were evaluated. The primary outcome measures were operative time, length of stay (LOS), and conversion, complication, and readmission rates for each cohort.

Results

A total of 160 patients were evaluated—80 in each cohort. Patients were well matched in demographics, diagnosis, and procedure variables. The obese cohort had significantly higher BMI (p < 0.001) and ASA scores (p = 0.035). Operative time (176.9 ± 64.0 vs. 144.4 ± 47.2 min, p < 0.001) and estimated blood loss (89.0 ± 139.5 vs. 51.6 ± 38.0 ml, p < 0.001) were significantly higher in the obese. There were no significant differences in conversion rates (p = 0.682), final incision length (p = 0.088), LOS (p = 0.332), postoperative complications (p = 0.430), or readmissions (p = 1.000) in the obese versus non-obese. Further, in malignant cases, lymph nodes harvested (p = 0.757) and negative distal margins (p = 1.000) were comparable across cohorts.

Conclusions

Single-incision laparoscopic colectomy in obese patients had significantly longer operative times, but comparable conversion rates, oncologic outcomes, lengths of stay, complication, and readmission rates as the non-obese cohorts. In the obese, where higher morbidity rates are typically associated with surgical outcomes, SILS may be the ideal platform to optimize outcomes in colorectal surgery. With additional operative time, the obese can realize the same clinical and quality benefits of minimally invasive surgery as the non-obese.
Literature
1.
Baskin ML, Ard J, Franklin F, Allison DB (2005) Prevalence of obesity in the United States. Obes Rev 6:5–7CrossRefPubMed
2.
Wang Y, Beydoun MA (2007) The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29:6–28CrossRefPubMed
3.
Morrill AC, Chinn CD (2004) The obesity epidemic in the United States. J Public Health Policy 25:353–366CrossRefPubMed
4.
Calle EE, Kaaks R (2004) Overweight, obesity and cancer: epidemiological evidence and proposed mechanisms. Nat Rev Cancer 4:579–591CrossRefPubMed
5.
Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH (1999) The disease burden associated with overweight and obesity. JAMA 282:1523–1529CrossRefPubMed
6.
Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237CrossRefPubMed
7.
Iorio T, Blumberg D (2014) Laparoscopic colectomy is feasible in the mega-obese patient using a standardized technique. Surg Obes Relat Dis 10:1005–1008CrossRefPubMed
8.
Vaccaro CA, Rossi GL, Quintana GO, Soriano ER, Vaccarezza H, Rubinstein F (2014) Laparoscopic colorectal resections: a simple predictor model and a stratification risk for conversion to open surgery. Dis Colon Rectum 57:869–874CrossRefPubMed
9.
Velchuru VR, Domajnko B, deSouza A et al (2014) Obesity increases the risk of postoperative peripheral neuropathy after minimally invasive colon and rectal surgery. Dis Colon Rectum 57:187–193CrossRefPubMed
10.
Wick EC, Hirose K, Shore AD et al (2011) Surgical site infections and cost in obese patients undergoing colorectal surgery. Arch Surg 146:1068–1072CrossRefPubMed
11.
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
12.
Bonjer HJ, Hop WC, Nelson H et al (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303CrossRefPubMed
13.
Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100:75–82CrossRefPubMed
14.
Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMed
15.
Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645CrossRefPubMed
16.
Buunen M, Veldkamp R, Hop WC et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52CrossRefPubMed
17.
Makino T, Trencheva K, Shukla PJ et al (2014) The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: a case-matched study of 152 patients. Surgery 156:661–668CrossRefPubMed
18.
Cai Y, Zhou Y, Li Z, Xiang J, Chen Z (2013) Surgical outcome of laparoscopic colectomy for colorectal cancer in obese patients: a comparative study with open colectomy. Oncol Lett 6:1057–1062PubMedCentralPubMed
19.
Poulsen M, Ovesen H (2012) Is laparoscopic colorectal cancer surgery in obese patients associated with an increased risk? Short-term results from a single center study of 425 patients. J Gastrointest Surg 16:1554–1558CrossRefPubMed
20.
Krane MK, Allaix ME, Zoccali M et al (2013) Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases. J Am Coll Surg 216:986–996CrossRefPubMed
21.
Hardiman K, Chang ET, Diggs BS, Lu KC (2013) Laparoscopic colectomy reduces morbidity and mortality in obese patients. Surg Endosc 27:2907–2910CrossRefPubMed
22.
Poon JT, Cheung CW, Fan JK, Lo OS, Law WL (2012) Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc 26:2729–2734CrossRefPubMed
23.
Vasilakis V, Clark CE, Liasis L, Papaconstantinou HT (2013) Noncosmetic benefits of single-incision laparoscopic sigmoid colectomy for diverticular disease: a case-matched comparison with multiport laparoscopic technique. J Surg Res 180:201–207CrossRefPubMed
24.
Chambers WM, Bicsak M, Lamparelli M, Dixon AR (2011) Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13:393–398CrossRefPubMed
25.
Bulut O, Nielsen CB, Jespersen N (2011) Single-port access laparoscopic surgery for rectal cancer: initial experience with 10 cases. Dis Colon Rectum 54:803–809CrossRefPubMed
26.
Kim SJ, Ryu GO, Choi BJ et al (2011) The short-term outcomes of conventional and single-port laparoscopic surgery for colorectal cancer. Ann Surg 254:933–940CrossRefPubMed
27.
Bucher P, Pugin F, Morel P (2010) Transumbilical single incision laparoscopic sigmoidectomy for benign disease. Colorectal Dis 12:61–65CrossRefPubMed
28.
Geisler D, Garrett T (2011) Single incision laparoscopic colorectal surgery: a single surgeon experience of 102 consecutive cases. Tech Coloproctol 15:397–401CrossRefPubMed
29.
Miller S, Causey MW, Damle A, Maykel J, Steele S (2013) Single-incision laparoscopic colectomy: training the next generation. Surg Endosc 27:1784–1790CrossRefPubMed
30.
Remzi FH, Kirat HT, Geisler DP (2010) Laparoscopic single-port colectomy for sigmoid cancer. Tech Coloproctol 14:253–255CrossRefPubMed
31.
Geisler DP, Condon ET, Remzi FH (2010) Single incision laparoscopic total proctocolectomy with ileopouch anal anastomosis. Colorectal Dis 12:941–943CrossRefPubMed
32.
Rieger NA, Lam FF (2010) Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation. Surg Endosc 24:888–890CrossRefPubMed
33.
Ross H, Steele S, Whiteford M et al (2011) Early multi-institution experience with single-incision laparoscopic colectomy. Dis Colon Rectum 54:187–192CrossRefPubMed
34.
Aytac E, Turina M, Gorgun E, Stocchi L, Remzi FH, Costedio MM (2014) Single-port laparoscopic colorectal resections in obese patients are as safe and effective as conventional laparoscopy. Surg Endosc 28:2884–2889CrossRefPubMed
35.
Sakamoto K, Niwa S, Tanaka M, Goto M, Sengoku H, Tomiki Y (2007) Influence of obesity on the short-term outcome of laparoscopic colectomy for colorectal cancer. J Minim Access Surg 3:98–103PubMedCentralCrossRefPubMed
36.
Fung AK, Aly EH (2012) Systematic review of single-incision laparoscopic colonic surgery. Br J Surg 99:1353–1364CrossRefPubMed
37.
Leroy J, Cahill RA, Asakuma M, Dallemagne B, Marescaux J (2009) Single-access laparoscopic sigmoidectomy as definitive surgical management of prior diverticulitis in a human patient. Arch Surg 144:173–179 discussion 179 CrossRefPubMed
38.
Champagne BJ, Lee EC, Leblanc F, Stein SL, Delaney CP (2011) Single-incision vs straight laparoscopic segmental colectomy: a case-controlled study. Dis Colon Rectum 54:183–186CrossRefPubMed
39.
Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMed
40.
41.
Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72PubMedCentralPubMed
42.
Delaney CP, Marcello PW, Sonoda T, Wise P, Bauer J, Techner L (2010) Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc 24:653–661CrossRefPubMed
43.
44.
Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMed
45.
Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824CrossRefPubMed
Metadata
Title
Outcomes for single-incision laparoscopic colectomy surgery in obese patients: a case-matched study
Authors
Deborah S. Keller
Sergio Ibarra
Juan Ramon Flores-Gonzalez
Oscar Moreno Ponte
Nisreen Madhoun
T. Bartley Pickron
Eric M. Haas
Publication date
01-02-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-015-4268-9

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