TY - JOUR
T1 - Small bowel obstruction, incisional hernia and survival after laparoscopic and open colonic resection (LAFA study)
AU - Bartels, S.A.
AU - Vlug, M.S.
AU - Hollmann, M.W.
AU - Dijkgraaf, M.G.
AU - Ubbink, D.T.
AU - Cense, H. A.
AU - van Wagensveld, B.A.
AU - Engel, A.F.
AU - Gerhards, M.F.
AU - Lafa Study Group (incl. Dejong), C.
AU - Bemelman, W.A.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - BACKGROUND: Short-term advantages to laparoscopic surgery are well described. This study compared medium- to long-term outcomes of a randomized clinical trial comparing laparoscopic and open colonic resection for cancer. METHODS: The case notes of patients included in the LAFA study (perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care) were reviewed 2-5 years after randomization for incisional hernia, adhesional small bowel obstruction (SBO), overall survival, cancer recurrence and quality of life (QoL). The laparoscopic and open groups were compared irrespective of fast-track or standard perioperative care. RESULTS: Data on incisional hernias, SBO, survival and recurrence were available for 399 of 400 patients: 208 laparoscopic and 191 open resections. These outcomes were corrected for duration of follow-up. Median follow-up was 3.4 (i.q.r. 2.6-4.4) years. Multivariable regression analysis showed that open resection was a risk factor for incisional hernia (odds ratio (OR) 2.44, 95 per cent confidence interval (c.i.) 1.12 to 5.26; P = 0.022) and SBO (OR 3.70, 1.07 to 12.50; P = 0.039). There were no differences in overall survival (hazard ratio 1.10, 95 per cent c.i. 0.67 to 1.80; P = 0.730) or in cumulative incidence of recurrence (P = 0.514) between the laparoscopic and open groups. There were no measured differences in QoL in 281 respondents (P > 0.350 for all scales). CONCLUSION: Laparoscopic colonic surgery led to fewer incisional hernia and adhesional SBO events. Registration number: NTR222 (http://www.trialregister.nl).
AB - BACKGROUND: Short-term advantages to laparoscopic surgery are well described. This study compared medium- to long-term outcomes of a randomized clinical trial comparing laparoscopic and open colonic resection for cancer. METHODS: The case notes of patients included in the LAFA study (perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care) were reviewed 2-5 years after randomization for incisional hernia, adhesional small bowel obstruction (SBO), overall survival, cancer recurrence and quality of life (QoL). The laparoscopic and open groups were compared irrespective of fast-track or standard perioperative care. RESULTS: Data on incisional hernias, SBO, survival and recurrence were available for 399 of 400 patients: 208 laparoscopic and 191 open resections. These outcomes were corrected for duration of follow-up. Median follow-up was 3.4 (i.q.r. 2.6-4.4) years. Multivariable regression analysis showed that open resection was a risk factor for incisional hernia (odds ratio (OR) 2.44, 95 per cent confidence interval (c.i.) 1.12 to 5.26; P = 0.022) and SBO (OR 3.70, 1.07 to 12.50; P = 0.039). There were no differences in overall survival (hazard ratio 1.10, 95 per cent c.i. 0.67 to 1.80; P = 0.730) or in cumulative incidence of recurrence (P = 0.514) between the laparoscopic and open groups. There were no measured differences in QoL in 281 respondents (P > 0.350 for all scales). CONCLUSION: Laparoscopic colonic surgery led to fewer incisional hernia and adhesional SBO events. Registration number: NTR222 (http://www.trialregister.nl).
U2 - 10.1002/bjs.9585
DO - 10.1002/bjs.9585
M3 - Article
SN - 0007-1323
VL - 101
SP - 1153
EP - 1159
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 9
ER -