Clinical benefits of single-incision laparoscopic surgery for postoperative delirium in elderly colon cancer patients

Nishizawa, Yujiro; Hata, Taishi; Takemasa, Ichiro; Yamasaki, Makoto; Akasaka, Hiroshi; Sugimoto, Ken; Tamai, Koki; Takahashi, Hidekazu; Haraguchi, Naotsugu; Nishimura, Junichi; Matsuda, Chu; Mizushima, Tsunekazu; Ikenaga, Masakazu; Yamamoto, Hirofumi; Murata, Kohei; Rakugi, Hiromi; Doki, Yuichiro; Mori, Masaki

doi:10.1007/s00464-017-5827-z

Cited by 20 publications

(15 citation statements)

References 21 publications

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“…There are many factors affecting delirium after surgery, and pain is one of the factors [18]. Studies have shown that low IAP can reduce pain in patients during laparoscopic surgery [19][20][21].…”

Section: Resultsmentioning

confidence: 99%

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Weidong

Mengda

et al. 2020

Preprint

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Background: Robot-assisted laparoscopic radical prostatectomy ( RALRP) has better effects than conventional laparoscopic radical prostatectomy (LRP). However, there were few research focus on the incidence and risk factors of postoperative delirium for patients with different procedures. Methods: Eighty-one cases of RLRP patients (group RALRP) and 71 cases of LRP patients (group LRP) under general anesthesia were collected from anesthesia information system from June 2013 to December 2019. Comparison of the time of preparation period before surgery(Tp), time of operation(To), time of anesthesia maintenance (Ta), time of anesthesia recovery(time from cessation of intravenous anesthetic to endotracheal extubation, Tr), time of endotracheal extubation(time from endotracheal extubation to discharge from post-anesthesia care unit, Te), dosage of anesthetic (propofol, sufentanil, remifentanil), PaCO2, plasma lactate level and airway pressure at different points (before pneumoperitoneum, post-pneumoperitoneum, after loosening pneumoperitoneum), the incidences of postoperative delirium and utilization of mannitol, IAP, dosage of vasoactive agents(ephedrine, methoxamine and atropine), fluid infusion volume, blood transfusion volume, blood loss, postoperative hospitalization time (Th) and overall cost. Results: The incidences of postoperative delirium and utilization of mannitol in group RALRP and LRP were (17.3% VS 32.4%, P=0.03;7.4% VS 21.1%, P=0.014), Tr was (31.52±9.89 VS 38.65±16.32 min; P=0.01,95%CI 2.72-11.54), IAP was (12.72±1.87 VS 13.37±1.12 mmHg; P=0.01, 95%CI 0.16-1.14), PaCO2 at post-pneumoperitoneum and after loosening pneumoperitoneum were (47.89±10.89 VS 38.65±16.32 mmHg; P <0.001, 95%CI 6.47-11.98; 40.77±5.34 VS 43.57±4.54 mmHg; P=0.001, 95%CI 1.17-4.37), the difference was statistically significant. Tp, To, Ta and overall cost of patients in the RLRP group were significantly longer than those in the LRP group (P <0.02). No statistical difference was found in other observation variables. The incidence of postoperative delirium was considered as the dependent variable for binary logistic regression analysis. The result showed the incidence of postoperative delirium increased 1.17 times (95%CI 1.06-1.17), 1.13 times (95%CI 1.03-1.24), and 1.66 times (95%CI 1.02-2.70) for each unit increase in Tr, post-pneumoperitoneum PaCO2 and IAP.Conclusion: Compared with group LRP, patients in group RALRP had lower IAP, lower incidence of postoperative delirium and shorter recovery time, but the overall cost was higher. IAP is the main factor affecting the incidence of postoperative delirium.

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Section: Resultsmentioning

confidence: 99%

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Weidong

Mengda

et al. 2020

Preprint

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“…The application of SPLC in elderly patients remains controversial. To our knowledge, only two studies to date, both published in 2018, have specifically evaluated the outcomes of SPLC in elderly patients with colon cancer . One of these studies found no difference in outcomes between 86 elderly patients and 40 young patients who underwent SPLC for colon cancer.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only two studies to date, both published in 2018, have specifically evaluated the outcomes of SPLC in elderly patients with colon cancer. 6,11 One of these studies found no difference in outcomes between 86 elderly patients and 40 young patients who underwent SPLC for colon cancer. However, the authors of that study identified a limitation: potential bias toward the surgical approach.…”

Section: Discussionmentioning

confidence: 99%

Single‐port laparoscopic colectomy in elderly patients with colon cancer: A propensity score‐matched comparison with younger patients

Hirano

Hiranuma

Hattori

et al. 2019

Asian J Endoscop Surgery

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Introduction This study aims to evaluate the safety and feasibility of single‐port laparoscopic colectomy (SPLC) in elderly patients with colon cancer. Methods During the study period, 344 patients underwent SPLC in our hospital. Among them, 87 patients were aged 80 years and older, and 257 patients were younger than 80 years. After 1:1 propensity‐score matching, 87 elderly patients were compared with 87 young patients. Results Short‐term clinical outcomes after SPLC were equivalent between the two groups, although the elderly group had a higher ASA score and more postoperative complications. The 5‐year overall survival rates were 64.6% in the elderly group and 66.8% in control group. The 5‐year cancer‐specific survival rates were 78.0% in the elderly group and 70.9% in control group. There were no significant differences between the groups. Conclusion Our results indicated that SPLC is technically feasible for operative teams that have adequately standardized the procedure, and it is oncologically safe in elderly patients with colon cancer.

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“…The alpha level and power were set to 0.05 and 0.8, respectively. According to previous pilot tests [ 28 , 29 ], the incidence of the primary outcome was 30%. After calculation, an average of 47 patients was required in each group.…”

Section: Methodsmentioning

confidence: 99%

Effects of Abdominal Wall Blocks on Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Study

et al. 2021

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Background Postoperative delirium (POD) seriously affects the rapid postoperative recovery of elderly patients. We investigated the effect of abdominal wall blocks on POD in elderly patients undergoing laparoscopic radical resection of colon cancer and underlying mechanisms. Material/Methods A total of 100 patients undergoing laparoscopic radical resection of colon cancer were randomly assigned to group C (control) and group R (regional nerve blocks). In group R, 20 mL of local anesthesia-mixed solution was injected into the bilateral transverse abdominis muscle plane and 10 mL was injected into the bilateral posterior sheath of the rectus abdominis muscle. In group C, the same amount of saline was used for nerve block. The consumption of propofol and remifentanil during surgery was recorded. Levels of serum interleukin (IL)-6 and highly sensitive C-reactive protein (hs-CRP) during surgery were evaluated. The Confusion Assessment Method for the Intensive Care Unit Scale and the Richmond Agitation-Sedation Scale were adopted to evaluate POD. Results The incidence of POD was lower in group R than in group C ( P =0.048). The consumption of propofol and remifentanil was significantly reduced in group R, compared with group C ( P <0.05). Compared with T0, serum IL-6 and hs-CRP levels in both groups were significantly increased at T1 and T2 ( P <0.05). Moreover, serum IL-6 and hs-CRP were lower at T1 and T2 in group R compared with group C ( P <0.05). Conclusions Abdominal wall blocks may alleviate POD in elderly patients undergoing laparoscopic surgery, which may be related to the reduction of anesthetic consumption and inflammatory response.

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Clinical benefits of single-incision laparoscopic surgery for postoperative delirium in elderly colon cancer patients

Abstract: SLS for elderly colon cancer patients may lower the incidence of POD compared with CLS.

Cited by 20 publications

References 21 publications

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Comparison of Robot-assisted Versus Conventional Laparoscope on Incidence and Risk Factors of Postoperative Delirium for Patients undergoing radical prostatectomy: A single-center Retrospective Analysis

Single‐port laparoscopic colectomy in elderly patients with colon cancer: A propensity score‐matched comparison with younger patients

Effects of Abdominal Wall Blocks on Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Study

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