Laparoscopic surgery for colorectal cancer patients who underwent previous abdominal surgery

Abstract

Background: Laparoscopic colorectal surgery may be impeded by intraperitoneal adhesions caused by previous abdominal surgery. The aim of this study was to determine the effect of previous abdominal surgery on short- and long-term outcomes of laparoscopic colorectal surgery.

Methods: We retrospectively reviewed 3188 patients with primary colorectal cancer who underwent laparoscopic colorectal surgery between January 2004 and December 2013. Patients with a history of abdominal surgery (n = 593, 18.6 %) were compared to those without such history (n = 2595, 81.4 %).

Results: Patients who had undergone previous abdominal surgery exhibited acceptable intraoperative outcomes, including conversion to open surgery, operative time, estimated blood loss, and the number of harvested lymph nodes. Overall, postoperative complication rates were similar between the groups (10.8 vs. 10.6 %, p = 0.885). Subgroup analysis revealed that patients with history of major abdominal surgery (n = 165) had higher rates of conversion to open surgery (4.2 vs. 1.7 %, p = 0.033), prolonged postoperative ileus (5.5 vs. 2.0 %, p = 0.008), and wound complications (4.2 vs. 1.2 %, p = 0.006), when compared to those without prior abdominal surgery. Previous major abdominal surgery was an independent risk factor for conversion to open surgery [adjusted odds ratio = 2.740; 95 % confidence interval (CI) 1.197-6.269]. Disease-free survival [adjusted hazard ratio (HR) = 0.847; 95 % CI 0.532-1.346] and overall survival (adjusted HR = 0.846; 95 % CI 0.432-1.657) were not observed to differ between the previous major abdominal surgery group and those without previous abdominal surgery.

Conclusion: Laparoscopic colorectal surgery in patients with a history of abdominal surgery exhibited acceptable short- and long-term outcomes. Patients with a history of previous abdominal surgery had relatively higher rate of conversion to open surgery as well as higher incidences of prolonged postoperative ileus and wound complications compared to patients without such history.

Keywords: Adhesion; Colorectal surgery; Laparoscopy.