Analysis of Laparoscopic Colorectal Surgery in High-risk Patients

Abstract

The aim of this retrospective study is to examine the feasibility and safety of laparoscopic colorectal resection for colorectal malignancies to determine "high-risk" patients. In our classification, 3 minor criteria including patients over 70 years of age, body mass index over 30 m/kg, and cigarette smoking and 5 major criteria including cardiac, pulmonary, renal, liver disease, and diabetes mellitus were selected to determine a high-risk group. Patients carrying 1 minor and 1 major criteria were classified as the high-risk group. Concerning patients and operations, hemodynamic values (mean arterial systolic and diastolic pressures and heart rates), oxygen saturations, end-expiratory carbon dioxide levels, respiratory mechanics (dynamic compliance, peak inspiratory pressure, airway resistance) were analyzed. Cardiovascular system (myocardial infarction, arrhythmia, hypertension), pulmonary system (respiratory insufficiency), digestive system (anastomotic leak, fistula, and paralytic ileus), fever, thrombophlebitis, urinary infections, wound infections, and central nervous system (delirium and cerebrovascular accident) were also investigated. A total number of 85 high-risk patients were included in the study. Gastrointestinal leaks in 2.3%, fistula in 1.1%, ileus in 3.5%, postoperative bleeding in 2.3%, postoperative fever in 5.8%, wound infection in 5.8%, and cerebrovascular accidents in 1.1% of patients were detected. The lowest values of hemodynamic and respiratory mechanics were observed at the induction of pneumoperitoneum and in this period the compliance and mean arterial pressure were determined to be 36+/-14 mm Hg and 84+/-14 mm Hg, respectively. No mortalities occurred. In experienced hands, laparoscopic colorectal resection can be performed safely for "high-risk" surgical patients.

Long-term outcomes and propensity score matching analysis: rectal cancer resection for patients with elevated preoperative risk

“…It is well accepted that laparoscopic approach is equivalent in the treatment of rectal cancer and shows advantages of shorter hospitalization and faster recovery, lower blood loss and lower complications rates [19], especially in patients with low rectal cancer [20, 21, 22]. …”

The Effects of Different Oxygen Concentrations on Recruitment Maneuver During General Anesthesia for Laparoscopic Surgery

“…7,8 In terms of respiratory mechanics and oxygenation, a number of recent studies have shown the usefulness of RM, which are applied during pneumoperitonium and laparoscopic surgery. [9][10][11][12][13] The duration of the maneuvers and the applied pressure values have been defined in detail in previous studies. Despite these detailed definitions, the effects of oxygen and oxygen percentage used during the process have not been an area of focus.…”

Risk Criteria for Scientific Researches. For Whom the Bell Tolls?

“…The investigators used similar criteria to identify high-risk patients like we firstly defined in our previous study. 2 In our study, we defined five major criteria including cardiac, pulmonary, renal or liver disease, and diabetes mellitus and three minor criteria including age >70 years, body mass index >30 kg/m 2 , and smoking. The minor criteria were exactly the same in those two studies, but Kang et al did not determine all cardiac diseases as a major risk factor; rather, they determined congestive heart failure, valvular heart disease, and anemia as separate major risk factors.…”