TY - JOUR
T1 - Multicenter Observational Study of Adhesion Formation after Open-and Laparoscopic Surgery for Colorectal Cancer
AU - Stommel, Martijn W. J.
AU - ten Broek, Richard P. G.
AU - Strik, Chema
AU - Slooter, Gerrit D.
AU - Verhoef, Cornelis
AU - Grünhagen, Dirk J.
AU - van Duijvendijk, Peter
AU - Bemelmans, Marc H. A.
AU - den Dulk, Marcel
AU - Sietses, Colin
AU - van Heek, Tjarda N. T.
AU - van den Boezem, Peter B.
AU - de Wilt, Johannes H. W.
AU - van Goor, Harry
PY - 2018
Y1 - 2018
N2 - Objective: The aim of this study was to compare adhesion formation after laparoscopic and open colorectal cancer resection. Summary of Background Data: After colorectal surgery, most patients develop adhesions, with a high burden of complications. Laparoscopy seems to reduce adhesion formation, but evidence is poor. Trials comparing open- and laparoscopic colorectal surgery have never assessed adhesion formation. Methods: Data on adhesions were gathered during resection of colorectal liver metastases. Incidence of adhesions adjacent to the original incision was compared between patients with previous laparoscopic- and open colorectal resection. Secondary outcomes were incidence of any adhesions, extent and severity of adhesions, and morbidity related to adhesions or adhesiolysis. Results: Between March 2013 and December 2015, 151 patients were included. Ninety patients (59.6%) underwent open colorectal resection and 61 patients (40.4%) received laparoscopic colorectal resection. Adhesions to the incision were present in 78.9% after open and 37.7% after laparoscopic resection (P < 0.001). The incidence of abdominal wall adhesions and of any adhesion was significantly higher after open resection; the incidence of visceral adhesions did not significantly differ. The extent of abdominal wall and visceral adhesions and the median highest Zühlke score at the incision were significantly higher after open resection. There were no differences in incidence of small bowel obstruction during the interval between the colorectal and liver operations, the incidence of serious adverse events, and length of stay after liver surgery. Conclusion: Laparoscopic colorectal cancer resection is associated with a lower incidence, extent, and severity of adhesions to parietal surfaces. Laparoscopy does not reduce the incidence of visceral adhesions.
AB - Objective: The aim of this study was to compare adhesion formation after laparoscopic and open colorectal cancer resection. Summary of Background Data: After colorectal surgery, most patients develop adhesions, with a high burden of complications. Laparoscopy seems to reduce adhesion formation, but evidence is poor. Trials comparing open- and laparoscopic colorectal surgery have never assessed adhesion formation. Methods: Data on adhesions were gathered during resection of colorectal liver metastases. Incidence of adhesions adjacent to the original incision was compared between patients with previous laparoscopic- and open colorectal resection. Secondary outcomes were incidence of any adhesions, extent and severity of adhesions, and morbidity related to adhesions or adhesiolysis. Results: Between March 2013 and December 2015, 151 patients were included. Ninety patients (59.6%) underwent open colorectal resection and 61 patients (40.4%) received laparoscopic colorectal resection. Adhesions to the incision were present in 78.9% after open and 37.7% after laparoscopic resection (P < 0.001). The incidence of abdominal wall adhesions and of any adhesion was significantly higher after open resection; the incidence of visceral adhesions did not significantly differ. The extent of abdominal wall and visceral adhesions and the median highest Zühlke score at the incision were significantly higher after open resection. There were no differences in incidence of small bowel obstruction during the interval between the colorectal and liver operations, the incidence of serious adverse events, and length of stay after liver surgery. Conclusion: Laparoscopic colorectal cancer resection is associated with a lower incidence, extent, and severity of adhesions to parietal surfaces. Laparoscopy does not reduce the incidence of visceral adhesions.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85013059177&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/28207436
U2 - https://doi.org/10.1097/SLA.0000000000002175
DO - https://doi.org/10.1097/SLA.0000000000002175
M3 - Article
C2 - 28207436
SN - 0003-4932
VL - 267
SP - 743
EP - 748
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -