Effectiveness of colorectal laparoscopic surgery on patients at high anesthetic risk: an intervention cohort study
Date
2008Abstract
Aims The aim of the study was to assess the effectiveness of
laparoscopic colorectal surgery in patients at high preoper-
ative anesthetic risk because of associated pathologies.
Materials and methods From January 2003 until January
2005, 116 patients were systematically assigned at a ratio of
1:1 to one of two groups: laparoscopy surgery (n=59, of which
31 were American Society of Anesthesiologists score [ASA]
I–II [L1] and 28 ASA III–IV [L2]) or open surgery (n=57, of
which 30 were ASA I–II [O1] and 27 ASA III–IV [O2]).
Data on patient demographics and clinical and anesthetic
variables were collected prospectively. Informed consent was
obtained from the patients, and approval was obtained from
the designated review board of the institution involved.
Results The number of minor anesthetic complications
during surgery was higher in L2 patients. No differences
were observed in blood gas parameters studied during
surgery (pCO 2 , pH, and pO 2 /FiO 2 ). Transfusion rates in the
laparoscopy group at greater anesthetic risk (L2) were lower
than those of the high-risk conventional surgery group (O2;
21.4 vs 63%, P<0.02). Duration of stay in the surgical
recovery room and the inpatient ward were also shorter in
the L2 group than in the O2 group (8.7±4.5 vs 12.2±
6 days, P=0.02). There was no difference in perioperative
clinical variables between laparoscopy groups (L1, L2).
Conclusion Postoperative recovery of ASA III–IV patients
is better after laparoscopic surgery for colorectal cancer, at
the expense of a higher rate of minor anesthetic occurrences
during surgery