Top

Published in:

Open Access 01-11-2019 | Original Article

Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications?

Authors: Kazuhiro Taguchi, Manabu Shimomura, Hiroyuki Egi, Minoru Hattori, Shoichiro Mukai, Masatoshi Kochi, Haruki Sada, Yusuke Sumi, Ikki Nakashima, Shintaro Akabane, Koki Sato, Hideki Ohdan

Published in: Surgery Today | Issue 11/2019

Abstract

Purpose

The number of patients on antiplatelet therapy (APT) who need surgery is increasing; however, it is unclear whether APT should be continued for abdominal surgery, particularly laparoscopic colorectal surgery. We investigated the safety of continuing APT for patients undergoing laparoscopic colorectal surgery.

Methods

We collected retrospective data from 529 patients who underwent laparoscopic colorectal surgery at Hiroshima University between January, 2013 and December, 2018. We analyzed information related to APT. Thirty-six pairs were matched by the propensity score method between patients on APT (APT+) and those not on APT (APT−). We compared the surgical outcomes of both groups.

Results

Among 463 patients eligible for the study, 48 were on APT for cerebrovascular or cardiovascular disease, and 36 continued to take aspirin. In the case-matched comparison, the amount of intraoperative blood loss in the APT+ group was not significantly higher than that in the APT− group, and the incidences of bleeding complications, thromboembolic complications, and other complications were not significantly different between the groups.

Conclusion

In a case-matched comparison, continuation of aspirin during laparoscopic colorectal surgery did not increase perioperative complications. In laparoscopic colorectal surgery, continuation of aspirin is an acceptable strategy for patients with thromboembolic risk caused by interruption of APT.

Sibon I, Orgogozo JM. Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology. 2004;62(7):1187–9.CrossRefPubMed

Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol. 2005;62(8):1217–20. https://doi.org/10.1001/archneur.62.8.1217.CrossRefPubMed

Biondi-Zoccai GG, Lotrionte M, Agostoni P, Abbate A, Fusaro M, Burzotta F, et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. Eur Heart J. 2006;27(22):2667–74. https://doi.org/10.1093/eurheartj/ehl334.CrossRefPubMed

Mita K, Ito H, Murabayashi R, Sueyoshi K, Asakawa H, Nabetani M, et al. Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents. Ann Surg Oncol. 2012;19(12):3745–52. https://doi.org/10.1245/s10434-012-2500-6.CrossRefPubMed

Burger W, Chemnitius JM, Kneissl GD, Rucker G. Low-dose aspirin for secondary cardiovascular prevention—cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation—review and meta-analysis. J Intern Med. 2005;257(5):399–414. https://doi.org/10.1111/j.1365-2796.2005.01477.x.CrossRefPubMed

Columbo JA, Lambour AJ, Sundling RA, Chauhan NB, Bessen SY, Linshaw DL, et al. A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery. Ann Surg. 2018;267(1):1–10. https://doi.org/10.1097/SLA.0000000000002279.CrossRefPubMed

Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359(9325):2224–9. https://doi.org/10.1016/S0140-6736(02)09290-5.CrossRefPubMed

Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–84. https://doi.org/10.1016/S1470-2045(05)70221-7.CrossRefPubMed

Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg. 2008;248(5):728–38. https://doi.org/10.1097/SLA.0b013e31818b7595.CrossRefPubMed

10.

van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8. https://doi.org/10.1016/S1470-2045(13)70016-0.CrossRefPubMed

11.

Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, et al. Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan Clinical Oncology Group Study JCOG 0404. Ann Surg. 2014;260(1):23–30. https://doi.org/10.1097/SLA.0000000000000499.CrossRefPubMed

12.

Fujikawa T, Tanaka A, Abe T, Yoshimoto Y, Tada S, Maekawa H, et al. Does antiplatelet therapy affect outcomes of patients receiving abdominal laparoscopic surgery? Lessons from more than 1000 laparoscopic operations in a single tertiary referral hospital. J Am Coll Surg. 2013;217(6):1044–53. https://doi.org/10.1016/j.jamcollsurg.2013.08.005.CrossRefPubMed

13.

Ono K, Idani H, Hidaka H, Kusudo K, Koyama Y, Taguchi S. Effect of aspirin continuation on blood loss and postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection. Surg Laparosc Endosc Percutaneous Tech. 2013;23(1):97–100. https://doi.org/10.1097/SLE.0b013e318278cdf8.CrossRef

14.

Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell DA Jr, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344–50. https://doi.org/10.1097/SLA.0b013e3181b7fca6.CrossRefPubMed

15.

Fujimoto K, Fujishiro M, Kato M, Higuchi K, Iwakiri R, Sakamoto C, et al. Guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. Dig Endosc. 2014;26(1):1–14. https://doi.org/10.1111/den.12183.CrossRefPubMed

16.

Fujikawa T, Tanaka A, Abe T, Yoshimoto Y, Tada S, Maekawa H. Effect of antiplatelet therapy on patients undergoing gastroenterological surgery: thromboembolic risks versus bleeding risks during its perioperative withdrawal. World J Surg. 2015;39(1):139–49. https://doi.org/10.1007/s00268-014-2760-3.CrossRefPubMed

17.

Shimomura M, Kochi M, Hinoi T, Egi H, Adachi T, Kobayashi T, et al. Clinical significance of pharmacological prophylaxis based on the original risk classification of venous thromboembolism after lower abdominal surgery. Hiroshima J Med Sci. 2016;65(3–4):53–9.PubMed

18.

Kochi M, Shimomura M, Hinoi T, Egi H, Tanabe K, Ishizaki Y, et al. possible role of soluble fibrin monomer complex after gastroenterological surgery. World J Gastroenterol. 2017;23(12):2209–16. https://doi.org/10.3748/wjg.v23.i12.2209.CrossRefPubMedPubMedCentral

19.

Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr, et al. Prevention of venous thromboembolism. Chest. 2001;119(1 Suppl):132S–75S.CrossRefPubMed

20.

Shiga M, Maeda H, Oba K, Okamoto K, Namikawa T, Fujisawa K, et al. Safety of laparoscopic surgery for colorectal cancer in patients over 80 years old: a propensity score matching study. Surg Today. 2017;47(8):951–8. https://doi.org/10.1007/s00595-017-1470-5.CrossRefPubMed

21.

Morner ME, Gunnarsson U, Jestin P, Svanfeldt M. The importance of blood loss during colon cancer surgery for long-term survival: an epidemiological study based on a population based register. Ann Surg. 2012;255(6):1126–8. https://doi.org/10.1097/SLA.0b013e3182512df0.CrossRefPubMed

22.

Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S–77S. https://doi.org/10.1378/chest.11-2297.CrossRefPubMedPubMedCentral

23.

Sakon M, Maehara Y, Yoshikawa H, Akaza H. Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost. 2006;4(3):581–6. https://doi.org/10.1111/j.1538-7836.2006.01786.x.CrossRefPubMed

24.

Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg. 2001;88(7):913–30. https://doi.org/10.1046/j.0007-1323.2001.01800.x.CrossRefPubMed

Title: Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications?
Authors: Kazuhiro Taguchi
Manabu Shimomura
Hiroyuki Egi
Minoru Hattori
Shoichiro Mukai
Masatoshi Kochi
Haruki Sada
Yusuke Sumi
Ikki Nakashima
Shintaro Akabane
Koki Sato
Hideki Ohdan
Publication date: 01-11-2019
Publisher: Springer Singapore
Published in: Surgery Today / Issue 11/2019
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-019-01839-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2019

Verification of T descriptor with consolidation size for sub-centimeter non-small cell lung cancer

Long-term outcomes of patch tracheoplasty using collagenous tissue membranes (biosheets) produced by in-body tissue architecture in a beagle model

Conversion surgery for initially unresectable pancreatic cancer: current status and unresolved issues

Recombinant human soluble thrombomodulin reduces the severity and incidence of necrotizing enterocolitis in a newborn rat model

Efficiency of thoracoscopic palpation in localizing small pulmonary nodules

The quality of life after laparoscopic ventral and incisional hernia repair with closure and non-closure of fascial defect