A Multivariate Analysis of Potential Risk Factors for Intra- and Postoperative Complications in 1316 Elective Laparoscopic Colorectal Procedures

Kirchhoff, Philipp; Dinçler, Selim; Buchmann, P

doi:10.1097/sla.0b013e31817bbe3a

Cited by 185 publications

(151 citation statements)

References 14 publications

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“…La morbilidad y mortalidad de esta serie se encuentran en los límites inferiores de lo comunicado en la literatura 6 . Esto es el reflejo de un centro terciario de alta complejidad, con un relativo alto volumen de cirugía colorrectal laparoscópica; además los procedimientos fueron realizados por cirujanos colorrectales expertos o residentes de la subespecialidad directamente supervisados.…”

Section: Discussionunclassified

“…Los hallazgos mencionados anteriormente concuerdan parcialmente con otras series ya publicadas 6,9 . La necesidad de transfusión de glóbulos rojos intraoperatoria fue el factor con mayor fuerza de asociación.…”

Section: Discussionunclassified

“…En resultados a corto plazo, un reciente meta análisis mostró una asociación con mayores infecciones postoperatorias, necesidad de re operación, mayor tiempo de estadía postoperatoria y mortalidad por cualquier causa en pacientes que recibieron transfusión 13 . Por otro lado, el puntaje ASA es un factor conocido que ha sido asociado consistentemente con morbilidad y mortalidad perioperatoria en cirugía colorrectal tanto abierta como laparoscópica 6,9 , sin embargo, en una serie más reciente este factor no se asoció a complicación 14 .…”

Section: Discussionunclassified

“…Numerosas publicaciones han demostrado las ventajas del abordaje laparoscópico en cuanto a menor necesidad de analgésicos, menor tiempo de estadía hospitalaria, menor tiempo de reinicio de actividades regulares y menor infección de sitio quirúrgico [1][2][3][4][5] . Sin embargo, el abordaje mínimamente invasivo no está exento de complicaciones, su morbilidad descrita va entre un 6 y un 30% y la mortalidad entre 0 y 4,5% 6 .…”

Section: Factores Asociados a Morbilidad Precoz En Cirugía Colorrectaunclassified

“…Sin embargo, estos puntajes no se han logrado validar y son difíciles de aplicar en la práctica diaria, además sólo predicen mortalidad postoperatoria. Por esta razón, varios factores se han estudiado e intentado asociar a complicación postoperatoria en cirugía colorrectal, entre ellos se encuentra la experiencia del cirujano, edad, género masculino, elevado puntaje de ASA preoperatorio, cirugía rectal, neoplasia y cirugía de urgencia entre otros 6,9 . Todos estos factores han sido asociados a complicación, sin embargo, la asociación varía mucho en las distintas series publicadas, lo que explica que modelos predictivos de un centro no puedan ser replicados en otro centro posteriormente 10 .…”

Section: Factores Asociados a Morbilidad Precoz En Cirugía Colorrectaunclassified

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Factores asociados a morbilidad precoz en cirugía colorrectal laparoscópica

Gellona

et al. 2013

Rev Chil Cir

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Factors associated with early morbidity in laparoscopic colorectal surgery Introduction: Different factors have been associated with increased risk of complications in laparoscopic colorectal surgery. The aim of this study is to identify these factors in our series. Method: Retrospective cohort. All patients undergoing laparoscopic colorectal surgery between January 2000 and June 2012 were included. Patients who had postoperative complications until 30 days postoperatively were identified and analyzed by univariate and multivariate logistic regression. A p value less than 0.2 was used was used as a criteria for entry into the multivariate model. Results: The series consists of 848 patients with a median age of 58 ± 22 years. Main surgical indications were: neoplasia (42.3%), diverticular disease (27.8%) and inflammatory bowel disease (8.8%). Most frecuently-performed procedures were: sigmoidectomy (39.5%), anterior resection of the rectum (13.4%), right hemicolectomy (13%) and total colectomy (8.7%). On univariate analysis, factors associated with complications were age over 75 years (OR 1.82, 95% CI 1.02 to 3.25) and red blood cell transfusion (OR 8.47, 95% CI 3.69 to 19.43). On multivariate analysis, red blood cell transfusion (OR 7.9 95% CI 1.78 to 35.88) and ASA III or IV (OR 3.26 95% CI 1.01 to 17.23) were independent factors associated with postoperative complications. Conclusion: Intraoperative red blood cell transfusion and ASA score III or IV are independent risk factors associated with complications in laparoscopic colorectal surgery.

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Section: Discussionunclassified

Section: Factores Asociados a Morbilidad Precoz En Cirugía Colorrectaunclassified

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Factores asociados a morbilidad precoz en cirugía colorrectal laparoscópica

Gellona

et al. 2013

Rev Chil Cir

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Endoscopic Excision of Large Colorectal Polyps as a Viable Alternative to Surgical Resection

Kao¹

2011

Arch Surg

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To determine the outcome of endoscopic excision of large colorectal polyps. Design: Retrospective medical record review. Setting: Kaiser Permanente, a large health care maintenance organization. Patients: One hundred four consecutive patients with large colorectal lesions deemed not amenable to endoscopic resection at initial colonoscopy and referred for surgical resection. Intervention: Endoscopic excision under intravenous sedation by 2 interventional endoscopists. Main Outcomes Measures: Endoscopic success (the ability to completely eradicate the original or recurrent lesion endoscopically at the index procedure or at reintervention), procedure-related complications, disease recurrence, endoscopic reintervention, and surgical intervention. Results: We included 48 men (46%) and 56 women (54%) with a mean age of 67 (range, 29-92) years for analysis. Anatomic distribution of the lesions included the colon (68%) and rectum (32%). Thirty-nine patients (37%) had carcinoma. The median size of the lesions was 3.0 (range, 1-9) cm. The endoscopic success rate was 83% and was highest in patients with noncarcinoma histologic findings compared with carcinoma (PϽ.001). The morbidity rate was 7%, and all complications occurred in the ascending colon (P=.06). Endoscopic reintervention occurred in 25 of 92 patients (27%). Surgical intervention was undertaken in 14% of all patients. During a mean follow-up of 14 (median, 12) months, recurrent disease was noted in 10 of 86 patients (12%) and occurred more frequently in rectal lesions (P = .002). All recurrences were eradicated endoscopically. Conclusions: Endoscopic excision of large colorectal polyps is a viable alternative to surgical resection in a select group of patients and can be performed safely with a good success rate.

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