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Total abdominal colectomy for severe ulcerative colitis: does the laparoscopic approach really have benefit?

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Abstract

Background

It is still unknown to what extent the reported morbidity and recovery benefits of laparoscopic total abdominal colectomy (TAC) for severe ulcerative colitis (UC) are associated with patient selection bias. This study aimed to evaluate whether laparoscopic TAC has any advantages over open surgery after control for perioperative confounding factors.

Methods

Patients undergoing TAC for UC during 2006–2010 were identified. Demographics, disease characteristics, and perioperative outcomes were compared between laparoscopic and open TAC. Postoperative recovery and 30-day complications were further assessed by covariate-adjusted multivariate regression models. The outcomes of different laparoscopic techniques were compared. A subgroup analysis including surgeons who routinely used both laparoscopic and open techniques was also performed.

Results

Of the 412 eligible patients, the 197 patients undergoing laparoscopic TAC were significantly younger and had a decreased Charlson Comorbidity Index and ASA score, increased hemoglobin and serum albumin levels, and a smaller proportion of extensive colitis and urgent cases. Unadjusted analyses showed that intraoperative morbidity, postoperative mortality, and rates for readmission and reoperation were similar. Laparoscopic TAC was associated with a longer operative time but a decrease in blood loss, overall morbidity, ileus, and thromboembolism, as well as a faster return to bowel function and a shorter hospital stay. After covariate adjustments, laparoscopic surgery remained associated with a reduction in the time to stoma function, incidence of postoperative ileus, and hospital stay compared with open TAC. The rates of postoperative morbidity, readmission, and reoperation did not differ regardless whether the conventional multitrocar technique, hand-assisted procedure, or single-incision technique was used. Laparoscopic TAC among surgeons using both open and laparoscopic techniques was associated with recovery benefits similar to those observed in the overall study population.

Conclusion

The data suggest that laparoscopic TAC retains recovery advantages over open surgery even after adjustments for confounders.

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References

  1. Teeuwen PH, Stommel MW, Bremers AJ, van der Wilt GJ, de Jong DJ, Bleichrodt RP (2009) Colectomy in patients with acute colitis: a systematic review. J Gastrointest Surg 13:676–686

    Article  CAS  PubMed  Google Scholar 

  2. Cohen JL, Strong SA, Hyman NH, Buie WD, Dunn GD, Ko CY, Fleshner PR, Stahl TJ, Kim DG, Bastawrous AL, Perry WB, Cataldo PA, Rafferty JF, Ellis CN, Rakinic J, Gregorcyk S, Shellito PC, Kilkenny JW 3rd, Ternent CA, Koltun W, Tjandra JJ, Orsay CP, Whiteford MH, Penzer JR (2005) Practice parameters for the surgical treatment of ulcerative colitis. Dis Colon Rectum 48:1997–2009

    Article  PubMed  Google Scholar 

  3. Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH (2008) Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum 51:1202–1207; discussion 1207–1210

  4. Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS, Loftus EV Jr, Sandborn WJ, Wolff BG, Pemberton JH (2007) Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 204:956–962; discussion 962–953

    Google Scholar 

  5. Dunker MS, Bemelman WA, Slors JF, van Hogezand RA, Ringers J, Gouma DJ (2000) Laparoscopic-assisted vs open colectomy for severe acute colitis in patients with inflammatory bowel disease (IBD): a retrospective study in 42 patients. Surg Endosc 14:911–914

    Article  CAS  PubMed  Google Scholar 

  6. Seshadri PA, Poulin EC, Schlachta CM, Cadeddu MO, Mamazza J (2001) Does a laparoscopic approach to total abdominal colectomy and proctocolectomy offer advantages? Surg Endosc 15:837–842

    Article  CAS  PubMed  Google Scholar 

  7. Marcello PW, Milsom JW, Wong SK, Brady K, Goormastic M, Fazio VW (2001) Laparoscopic total colectomy for acute colitis: a case-control study. Dis Colon Rectum 44:1441–1445

    Article  CAS  PubMed  Google Scholar 

  8. Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y (2007) Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery 141:640–644

    Article  PubMed  Google Scholar 

  9. Ouaissi M, Lefevre JH, Bretagnol F, Alves A, Valleur P, Panis Y (2008) Laparoscopic 3-step restorative proctocolectomy: comparative study with open approach in 45 patients. Surg Laparosc Endosc Percutan Tech 18:357–362

    Article  PubMed  Google Scholar 

  10. Chung TP, Fleshman JW, Birnbaum EH, Hunt SR, Dietz DW, Read TE, Mutch MG (2009) Laparoscopic vs open total abdominal colectomy for severe colitis: impact on recovery and subsequent completion restorative proctectomy. Dis Colon Rectum 52:4–10

    Article  PubMed  Google Scholar 

  11. Watanabe K, Funayama Y, Fukushima K, Shibata C, Takahashi K, Sasaki I (2009) Hand-assisted laparoscopic vs open subtotal colectomy for severe ulcerative colitis. Dis Colon Rectum 52:640–645

    Article  PubMed  Google Scholar 

  12. Telem DA, Vine AJ, Swain G, Divino CM, Salky B, Greenstein AJ, Harris M, Katz LB (2010) Laparoscopic subtotal colectomy for medically refractory ulcerative colitis: the time has come. Surg Endosc 24:1616–1620

    Article  PubMed  Google Scholar 

  13. Kunitake H, Hodin R, Shellito PC, Sands BE, Korzenik J, Bordeianou L (2008) Perioperative treatment with infliximab in patients with Crohn’s disease and ulcerative colitis is not associated with an increased rate of postoperative complications. J Gastrointest Surg 12:1730–1736; discussion 1736–1737

    Google Scholar 

  14. Truelove SC, Witts LJ (1955) Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J 2:1041–1048

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Strong SA (2010) Management of acute colitis and toxic megacolon. Clin Colon Rectal Surg 23:274–284

    Article  PubMed Central  PubMed  Google Scholar 

  16. Colombel JF, Loftus EV Jr, Tremaine WJ, Pemberton JH, Wolff BG, Young-Fadok T, Harmsen WS, Schleck CD, Sandborn WJ (2004) Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 99:878–883

    Article  CAS  PubMed  Google Scholar 

  17. Ferrante M, D’Hoore A, Vermeire S, Declerck S, Noman M, Van Assche G, Hoffman I, Rutgeerts P, Penninckx F (2009) Corticosteroids but not infliximab increase short-term postoperative infectious complications in patients with ulcerative colitis. Inflamm Bowel Dis 15:1062–1070

    Article  CAS  PubMed  Google Scholar 

  18. Gu J, Stocchi L, Geisler DP, Kiran RP (2011) Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy? Surg Endosc 25:3294–3299

    Article  PubMed  Google Scholar 

  19. Kiran RP, Delaney CP, Senagore AJ, Steel M, Garafalo T, Fazio VW (2004) Outcomes and prediction of hospital readmission after intestinal surgery. J Am Coll Surg 198:877–883

    Article  PubMed  Google Scholar 

  20. Kiran RP, da Luz Moreira A, Remzi FH, Church JM, Lavery I, Hammel J, Fazio VW (2010) Factors associated with septic complications after restorative proctocolectomy. Ann Surg 251:436–440

    Article  PubMed  Google Scholar 

  21. Sajja SB, Schein M (2004) Early postoperative small bowel obstruction. Br J Surg 91:683–691

    Article  CAS  PubMed  Google Scholar 

  22. Stocchi L (2010) Laparoscopic surgery for ulcerative colitis. Clin Colon Rectal Surg 23:248–258

    Article  PubMed Central  PubMed  Google Scholar 

  23. Geisler DP, Kirat HT, Remzi FH (2011) Single-port laparoscopic total proctocolectomy with ileal pouch-anal anastomosis: initial operative experience. Surg Endosc 25:2175–2178

    Article  PubMed  Google Scholar 

  24. Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH (2001) “Fast track” postoperative management protocol for patients with high comorbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88:1533–1538

    Article  CAS  PubMed  Google Scholar 

  25. Senagore AJ, Delaney CP, Brady KM, Fazio VW (2004) Standardized approach to laparoscopic right colectomy: outcomes in 70 consecutive cases. J Am Coll Surg 199:675–679

    Article  PubMed  Google Scholar 

  26. Tan JJ, Tjandra JJ (2006) Laparoscopic surgery for ulcerative colitis: a meta-analysis. Colorectal Dis 8:626–636

    Article  CAS  PubMed  Google Scholar 

  27. Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH (2010) Laparoscopic approach significantly reduces surgical-site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211:232–238

    Article  PubMed  Google Scholar 

  28. Shapiro R, Vogel JD, Kiran RP (2011) Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum 54:1496–1502

    Article  PubMed  Google Scholar 

  29. Aytac E, Stocchi L, Vogel J, Kiran RP (2012) The minimally invasive approach minimizes the perioperative thromboembolic and bleeding complications for patients on chronic oral anticoagulant therapy undergoing colorectal surgery. The American Society of Colon & Rectal Surgeons Annual Scientific Meeting, San Antonio, p 98

  30. Masoomi H, Kang CY, Chaudhry O, Pigazzi A, Mills S, Carmichael JC, Stamos MJ (2012) Predictive factors of early bowel obstruction in colon and rectal surgery: data from the nationwide inpatient sample, 2006–2008. J Am Coll Surg 214:831–837

    Article  PubMed  Google Scholar 

  31. de Silva S, Ma C, Proulx MC, Crespin M, Kaplan BS, Hubbard J, Prusinkiewicz M, Fong A, Panaccione R, Ghosh S, Beck PL, Maclean A, Buie D, Kaplan GG (2011) Postoperative complications and mortality following colectomy for ulcerative colitis. Clin Gastroenterol Hepatol 9:972–980

    Article  PubMed  Google Scholar 

  32. da Luz Moreira A, Kiran RP, Kirat HT, Remzi FH, Geisler DP, Church JM, Garofalo T, Fazio VW (2010) Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc 24:1280–1286

    Article  PubMed  Google Scholar 

  33. Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255:228–236

    Article  PubMed  Google Scholar 

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Disclosure

Jinyu Gu, Luca Stocchi, Feza H. Remzi, and Ravi P. Kiran have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Ohio, Desk A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Jinyu Gu, Luca Stocchi, Feza H. Remzi & Ravi P. Kiran

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  1. Jinyu Gu
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  2. Luca Stocchi
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  3. Feza H. Remzi
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  4. Ravi P. Kiran
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Correspondence to Luca Stocchi.

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Gu, J., Stocchi, L., Remzi, F.H. et al. Total abdominal colectomy for severe ulcerative colitis: does the laparoscopic approach really have benefit?. Surg Endosc 28, 617–625 (2014). https://doi.org/10.1007/s00464-013-3218-7

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  • DOI: https://doi.org/10.1007/s00464-013-3218-7

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