Early results and complications of colorectal laparoscopic surgery and analysis of risk factors in 492 operated cases

Abstract

This study aimed to evaluate the early results of colorectal laparoscopic surgery with special attention to surgical and medical complications. The risk factors of such surgery are also investigated on the basis of a large series of operated cases: the preoperative knowledge of such factors could guide the operative program and the postoperative treatment with reduction of complications and improvement of the outcome. Between 1998 and 2008, 492 patients had been submitted to colorectal laparoscopic surgery by the same team: 387 for cancer and 105 for benign disease. All colorectal surgical operations are included in the series. No selection of the patients was made: laparoscopy was performed in all cases accepting the procedure. Several risk factors have been analysed in cases of fistula (age, pathology sex, type of the operation, cancer stages, preoperative radiochemotherapy, stool diversion and team experience) and in cases of medical complications (age, pathology, cancer stages and type of operation). The overall results in this series of laparoscopic colorectal operated cases are similar to other results published at present by the main surgical Department all over the world; no mortality and low number of medical (2.4%) and surgical complications (9.3%), with no differences also with the best open surgery series. Complete or partial conversion to open surgery was required in few cases (1.2%) and same others (1.4%) were operated again for bleeding or sudden anastomotic leakage. Regarding the risk factors in such surgery, a good correlation has been discovered between anastomotic leakage and the team experience, the age over 70 of the patients, the rectal tumour site in man, the advanced tumour stages, the previous radiochemotherapy, while medical complications seem to depend on advanced patients age and advanced cancer stages. Laparoscopic colorectal surgery at present is going to be considered the gold standard in the large majority of colorectal diseases including all cancer stages in the preoperative balance and in the early postoperative follow-up a special attention is required to same risk factors like the advanced patients age, the extended cancers, the low positioned rectal tumours. Complications are more frequent at the beginning of the experience of the surgical team and if more than one risk factors coexist, but it do not represent contraindication to laparoscopic surgery.

Exploring 6 years of colorectal cancer surgery in rural Italy: insights from 648 consecutive patients unveiling successes and challenges

“…In a such selected population of younger and healthier patients the surgical outcome becomes remarkable, approaching zero mortality with high laparoscopic resection rates [ 7 – 10 ]. In our series, the median age of the group of patient undergoing resection after elective hospitalization was significantly younger compared to that of the patients operated on after emergency admission (71 vs. 77 years), however, median age is still significantly higher compared to that reported in other Italian urban single center series (67 years) [ 8 , 10 ], where the incidence of patients aged less than 50 years can reach 10% [ 46 ]. In this larger group of patients, the laparoscopic resection rate reached 71.7%, and the postoperative mortality and LOS were 1.2% and 8 days, respectively (Tab.…”

Engineering Self-Assembled Nanomedicines Composed of Clinically Approved Medicines for Enhanced Tumor Nanotherapy

“…Due to the increasing incidence rate and the high hazards of cancer [1,2], it is a major medical problem that plagues humans [3,4]. Seriously, the dominant traditional treatments are problematic: surgery can be used to remove the lesions, but it easily leads to tumor recurrence and causes serious trauma to the body [5,6]; chemotherapy cannot achieve targeted therapy and usually causes toxic side effects on normal organs [7,8]; and radiotherapy can clear the pathological cell pointedly, but it will cause lesions in nearby tissues [9]. As a result, developing an efficient cancer-therapeutic modality that can realize targeted therapy, does not cause side effects, and can complete tumor eradication is highly necessary at the current stage.…”