Application Of Laparoscopic Assisted Colorectal Surgery In Obese Patients

PurposeThis study was aimed at assessing short-term outcome, survival time and disease free survival time after laparoscopic colectomy for colorectal cancer compared with open precedures in patients BMI>28.MethodFrom2007to2012,166eligible patients were included in this study. Laparoscopic colectomy was performed on64patients and the other102patients received open colectomy. The short-term outcome and postoperative survival rate were compared.ResultsLaparoscopic colectomy took longer duration of operation (183min vs167min, P<0.05) but decreased intraoperative blood loss (168ml vs188ml, P<0.05). Total hospitilization cost was slightly higher in laparoscopic group which is affordable for most patients (Y56484vsï¿¥56161, P<0.05). Decreased wound infection (17%vs31%, P<0.05) and abdominal absess (6%vs18%, P<0.05) was observed in the laparoscopic group. Pathological characteristics was similar between two groups. No significant difference was found with regard to the overall survival (log rank test, P=0.85) and disease free survival (log rank test, P=0.85) between (log rank test, P=0.76). ConclusionsOur retrospective study demonstrated better short-term outcome in laparoscopic colectomy for colorectal cancer compared to open procedure in patients with BMI>28. Laparoscopic colectomy is technically and oncologically safe and should be popularized in obese colorectal cancer patients. Background:As the global population of obese people and grows in the recent decades, surgical treatment of colorectal disease in this special group of patients has become a more challenging clinical problem. Obesity has been proved to be an independent factor that affects short-term surgical outcome and morbidity rate. This meta-analysis is performed to compare short-term surgical result between obese and nonobese patients having received laparoscopic colectomy. This study may provide evidence in clinical practice of laparoscopic technique in obese patients.Methods:Literatures published before2013was systematically searched. Intraoperative events including operative time, estimated blood loss and conversion was noted. Postoperative morbidity also got counted in this study. Weighted mean differences (WMD) was applied in analysing continuous data while odds ratio (OR) was used to analyze dichotomous data.Results:13eligible articles were included in this study. Significance difference were observed in operative time, estimated blood loss and conversion rate, with poor result in the obese group. Wound infection (13.2%vs2.6%, OR=4.27, P<0.00001), Anastomotic leak (5.3%vs1.2%, OR=2.35, P<0.006), Ileus (10.5%vs2.8%, OR=2.67, P<0.0001) and pulmonary complication (8.0%vs2.0%, OR=4.43, P<0.0001) were significantly increased in the obese group.Conclusion:After receving laparoscopic colectomy, obesity is associated with increased operative time, blood loss, conversion rate and higher morbidity rate (wound infection, anastomotic leak, ileus and pulmonary complication).