Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome

Abstract

Objective: The primary endpoint was to compare the impact of laparoscopic and open colorectal surgery on 30-day postoperative morbidity. Lymphocyte proliferation to mitogens and gut oxygen tension were surrogate endpoints.

Summary background data: Evidence-based proof of the effect of laparoscopic colorectal surgery on immunometabolic response and clinically relevant outcome variables is scanty. Further randomized trials are desirable before proposing laparoscopy as a superior technique.

Methods: Two hundred sixty-nine patients with colorectal disease were randomly assigned to laparoscopic (n = 136) or open (n = 133) colorectal resection. Four trained members of the surgical staff who were not involved in the study registered postoperative complications. Lymphocyte proliferation to Candida albicans and phytohemagglutinin was evaluated before and 3 and 15 days after surgery. Operative gut oxygen tension was monitored continuously by a polarographic microprobe.

Results: In the laparoscopic group the conversion rate was 5.1%. The overall morbidity rate was 20.6% in the laparoscopic group and 38.3% in the open group. Postoperative infections occurred in 15 of the 136 patients in the laparoscopic group and 31 of the 133 patients in the open group. The mean length of hospital stay was 10.4 +/- 2.9 days in the laparoscopic group and 12.5 +/- 4.1 days in the open group. On postoperative day 3, lymphocyte proliferation was impaired in both groups. Fifteen days after surgery, the proliferation index returned to baseline values only in the laparoscopic group. Intraoperative gut oxygen tension was higher in the laparoscopic than in the open group.

Conclusions: Laparoscopic colorectal surgery resulted in a significant reduction of 30-day postoperative morbidity. Lymphocyte proliferation and gut oxygen tension were better preserved in the laparoscopic group than in the open group.

Figure 1. Study design according to the CONSORT statement. LPS, laparoscopy.

Figure 2. Proliferative response of T cells to C. albicans. Data are reported as mean and standard deviation. LPS, laparoscopic group; POD, postoperative day. *P = .05, POD 3 vs. preoperative (LPS); **P = .03, POD 15 vs. POD 3 (LPS); +P = .04, POD 3 vs. preoperative (open group); ++P = .005, LPS vs. open.

Figure 3. Proliferative response of T cells to phytohemagglutinin. Data are reported as mean and standard deviation. LPS, laparoscopic group; POD, postoperative day. +P = .06, POD 15 vs. preoperative (open group); *P = .006, LPS vs. open.

Figure 4. Operative gut oxygen tension. Data are reported as mean and standard deviation. LPS, laparoscopic group. Overall P for repeated measures = .001. *Minimum P = .03, LPS vs. versus open.