Laparoscopic Major Gastrointestinal Surgery Is Safe for Properly Selected Patient with COPD: A Meta-Analysis

Abstract

Background. Laparoscopy has been widely applied in gastrointestinal surgery, with benefits such as less intraoperative blood loss, faster recovery, and shorter length of hospital stay. However, it remains controversial if laparoscopic major gastrointestinal surgery could be conducted for patients with chronic obstructive pulmonary disease (COPD) which was traditionally considered as an important risk factor for postoperative pulmonary complications. The present study was conducted to review and assess the safety and feasibility of laparoscopic major abdominal surgery for patient with COPD. Materials and Methods. Databases including PubMed, EmBase, Cochrane Library, and Wan-fang were searched for all years up to Jul 1, 2018. Studies comparing perioperative results for COPD patients undergoing major gastrointestinal surgery between laparoscopic and open approaches were enrolled. Results. Laparoscopic approach was associated with less intraoperative blood loss (MD = -174.03; 95% CI: −232.16 to -115.91, P < 0.00001; P < 0.00001, I2=93% for heterogeneity) and shorter length of hospital stay (MD = -3.30; 95% CI: −3.75 to -2.86, P < 0.00001; P = 0.99, I2=0% for heterogeneity). As for pulmonary complications, laparoscopic approach was associated with lower overall pulmonary complications rate (OR = 0.58; 95% CI: 0.48 to 0.71, P < 0.00001; P = 0.42, I2=0% for heterogeneity) and lower postoperative pneumonia rate (OR = 0.53; 95% CI: 0.41 to 0.67, P < 0.00001; P = 0.57, I2=0% for heterogeneity). Moreover, laparoscopic approach was associated with lower wound infection (OR = 0.51; 95% CI: 0.42 to 0.63, P < 0.00001; P = 0.99, I2=0% for heterogeneity) and abdominal abscess rates (OR = 0.59; 95% CI: 0.44 to 0.79, P < 0.0004; P = 0.24, I2=30% for heterogeneity). Conclusions. Laparoscopic major gastrointestinal surgery for properly selected COPD patient was safe and feasible, with shorter term benefits.

Laparoscopic Intervention to Pancreatic Pseudocyst Confers Short-Term Benefits: A Meta-Analysis

“…(3) Letters, conferences, and reviews. We followed the methods of Guo et al [ 8 ] in the process of study selection according to the inclusion and exclusion criteria.…”

“…We followed the methods of Guo et al [ 8 ] in data extraction and methodology quality assessment. Data of interest were extracted by two authors in an independent manner.…”

<p>Poor outcome of laparoscopic cholecystectomy in patients with COPD: how determinant it is? [Letter]</p>

“…A recent meta-analysis indicates that laparoscopic major gastrointestinal surgery in COPD patients is safe and has its own benefits including reduced overall postoperative pulmonary complications 5. However, proper patient selection is very important 5. While we very much welcome and accept the conclusion of the authors, we believe that the bad prognosis, ie, increased mortality and mechanical ventilation, shown and attributed to COPD needs to be judged in the above perspective too.…”

“…A recent meta-analysis indicates that laparoscopic major gastrointestinal surgery in COPD patients is safe and has its own benefits including reduced overall postoperative pulmonary complications 5. However, proper patient selection is very important 5.…”