Objective: To establish that the laparoscopic approach to colorectal resection is safe with regards to post- operative morbidity and mortality in patients eighty years of age and over. Methods: Prospectively collect- ...Objective: To establish that the laparoscopic approach to colorectal resection is safe with regards to post- operative morbidity and mortality in patients eighty years of age and over. Methods: Prospectively collect- ed data for consecutive patients aged eighty years and older who underwent laparoscopic colorectal resec-tion by the same surgeon (Dr Daniel R. Kozman) from 1st January 2009 till 31st March 2011, were retrospectively analysed. Data collected included baseline demographic information, operative indication, American Society of Anaesthesiologists (ASA) grading, procedure type, length of procedure, post-operative course, length of hospital stay, dis-charge destination and complications. Results: Thirty-one patients underwent laparoscopic colectomy during the study period, 28 for adenocarcinoma. The median age was 85.5 (range 80 - 92) years, 15 patients were male and 25 patients were from home. The mean operating time was 118.4 minutes (range 45 - 271). Conversion was required in only 4 of 31 cases (13%). The mortality rate was 10% in total, and 0% in elective cases. Three patients required re-operation, 2 of which initially presented in the emergency setting and were subsequently deceased. For survivors, the length of hospital stay was 8.1 days (range 3 - 30) with 100% returning to original place of residence. Conclusion/ Interpretation: Laparoscopic surgery in patients eighty years and over is safe and may be beneficial in the elective setting. This is evident by low complication rate, fast return to bowel function, short length of hospital stay, and likely return to pre-operative place of residence and low mortality rate in elective patients. Careful consideration should be given to its use in an emergency setting.展开更多
Background. Colonic malignant obstruction and perforated diverticulitis are acute left sided colonic emergencies (ALSCE) that are typically managed with colorectal resection. Colonic preservation techniques such as la...Background. Colonic malignant obstruction and perforated diverticulitis are acute left sided colonic emergencies (ALSCE) that are typically managed with colorectal resection. Colonic preservation techniques such as laparoscopic lavage and endoscopic stenting have emerged as management options, the safety of which has been debated. We aimed to determine if these alternate colonic preservation techniques result in increased in-hospital mortality. Materials and Methods. Retrospective analysis of prospectively collected data of 210 patients with ALSCE managed from June 2001 to April 2014. Data collected included demographic, pathology type, ASA grading, operative and post-operative progress. Univariable and multivariable logistic regression was performed to determine factors contributing to treatment arm allocation and in-hospital mortality. These were performed on the whole treatment cohort, as well as per pathology subgroup. Results. 210 patients were included. Non-resectional management was attempted in 147 patients (70%), of which 38 (26%) required un-planned colonic resection or died in hospital. Those treated with colonic preservation were younger, had lower ASA scores and had lower Hinchey scores (in the diverticular perforation group) than those in the resection group. Female gender was the only independent predictor of increased in-hospital mortality risk. Importantly, the type of procedure performed (colonic preservation vs. resection) did not predict in-hospital mortality risk. Conclusion. Attempted colonic preservation strategies do not increase the risk of in-hospital mortality in patients presenting with ALSCE. Given the inherent benefits of colonic preservation, these treatment strategies should be considered when managing ALSCE.展开更多
文摘Objective: To establish that the laparoscopic approach to colorectal resection is safe with regards to post- operative morbidity and mortality in patients eighty years of age and over. Methods: Prospectively collect- ed data for consecutive patients aged eighty years and older who underwent laparoscopic colorectal resec-tion by the same surgeon (Dr Daniel R. Kozman) from 1st January 2009 till 31st March 2011, were retrospectively analysed. Data collected included baseline demographic information, operative indication, American Society of Anaesthesiologists (ASA) grading, procedure type, length of procedure, post-operative course, length of hospital stay, dis-charge destination and complications. Results: Thirty-one patients underwent laparoscopic colectomy during the study period, 28 for adenocarcinoma. The median age was 85.5 (range 80 - 92) years, 15 patients were male and 25 patients were from home. The mean operating time was 118.4 minutes (range 45 - 271). Conversion was required in only 4 of 31 cases (13%). The mortality rate was 10% in total, and 0% in elective cases. Three patients required re-operation, 2 of which initially presented in the emergency setting and were subsequently deceased. For survivors, the length of hospital stay was 8.1 days (range 3 - 30) with 100% returning to original place of residence. Conclusion/ Interpretation: Laparoscopic surgery in patients eighty years and over is safe and may be beneficial in the elective setting. This is evident by low complication rate, fast return to bowel function, short length of hospital stay, and likely return to pre-operative place of residence and low mortality rate in elective patients. Careful consideration should be given to its use in an emergency setting.
文摘Background. Colonic malignant obstruction and perforated diverticulitis are acute left sided colonic emergencies (ALSCE) that are typically managed with colorectal resection. Colonic preservation techniques such as laparoscopic lavage and endoscopic stenting have emerged as management options, the safety of which has been debated. We aimed to determine if these alternate colonic preservation techniques result in increased in-hospital mortality. Materials and Methods. Retrospective analysis of prospectively collected data of 210 patients with ALSCE managed from June 2001 to April 2014. Data collected included demographic, pathology type, ASA grading, operative and post-operative progress. Univariable and multivariable logistic regression was performed to determine factors contributing to treatment arm allocation and in-hospital mortality. These were performed on the whole treatment cohort, as well as per pathology subgroup. Results. 210 patients were included. Non-resectional management was attempted in 147 patients (70%), of which 38 (26%) required un-planned colonic resection or died in hospital. Those treated with colonic preservation were younger, had lower ASA scores and had lower Hinchey scores (in the diverticular perforation group) than those in the resection group. Female gender was the only independent predictor of increased in-hospital mortality risk. Importantly, the type of procedure performed (colonic preservation vs. resection) did not predict in-hospital mortality risk. Conclusion. Attempted colonic preservation strategies do not increase the risk of in-hospital mortality in patients presenting with ALSCE. Given the inherent benefits of colonic preservation, these treatment strategies should be considered when managing ALSCE.
