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Impact of obesity on surgical outcomes after colorectal resection

AMERICAN JOURNAL OF SURGERY 2000年第4期179卷 275-281页

作者： Benoist, S Panis, Y Alves, A Valleur, P Hop Lariboisiere Serv Chirurg Gen & Digest Dept Surg F-75475 Paris 10 France

BACKGROUND: As the impact of obesity on surgical outcomes after colorectal resection is not well known, this study was designed to compare the results of colorectal resection in obese and nonobese patients. METHODS: From 1990 to 1997, 584 consecutive patients underwent elective colorectal resection in our department. Of these, 158 (27%) were obese (body mass index >27), Obese and nonobese patients were well matched for demographic data and surgical procedures. RESULTS: After right or left colectomy, no difference was noted between obese and nonobese patients for overall mortality, morbidity, or leakage rates. However, after left colectomy, postoperative intra-abdominal collections requiring treatment were significantly more frequent in obese than in nonobese patients (10% versus 2%;P <0.05). After proctectomy, the mortality rate was 5% (3 of 61) among obese patients and 0.5% (1 of 185) among nonobese patients (P <0.02), The anastomotic leakage rate was 16% (5 of 58) for obese patients and 6% (11 of 169) for nonobese patients (P <0.05), and the corresponding proportions of transfused patients were 43% and 19%, respectively (P <0.02). After proctectomy, multivariate analysis showed that for obese patients, diabetes mellitus (P <0.05) and American Society of Anesthesiologists (ASA) status >2 (P <0.05) were significant risk factors for anastomotic leakage;age >60 years (P <0.01) and ASA status >2 (P <0.05) were significant risk factors for perioperative blood transfusions. CONCLUSIONS: Our study suggested that, for obese patients, (1) right colectomy can be performed in the same manner as for nonobese patients;(2) after left colectomy, abdominal drainage may be indicated, and (3) after proctectomy, a defunctioning stoma should be recommended when diabetes mellitus or ASA status >2 is present, and an autologous blood transfusion could be discussed for patients >60 years old or with ASA status >2. Am J Surg. 2000;179:275-281. (C) 2000 by Excerpta Medica, Inc.

关键词：结肠切除术/方法结肠切除术/统计学和数值数据结肠疾病/并发症结肠疾病/外科学肥胖症/并发症手术后并发症/流行病学比例危险度模型直肠疾病/并发症直肠疾病/外科学直肠/外科学危险因素统计学非参数外科手术选择性/统计学和数值数据治疗结果老年人老年人 80以上女(雌)性人类男(雄)性中年人

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RESULTS OF COLECTOMY IN ELDERLY PATIENTS WITH COLON CANCER, BASED ON MEDICARE CLAIMS DATA

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AMERICAN JOURNAL OF SURGERY 1992年第6期163卷 572-576页

作者： WHITTLE, J STEINBERG, EP ANDERSON, GF HERBERT, R JOHNS HOPKINS UNIV DEPT MED BALTIMORE MD 21218 USA JOHNS HOPKINS UNIV CTR HOSP FINANCE & MANAGEMENT BALTIMORE MD 21218 USA JOHNS HOPKINS UNIV DEPT HLTH POLICY & MANAGEMENT BALTIMORE MD 21218 USA

Currently available estimates of outcomes following colon resection in elderly patients with colon cancer are based on series collected at academic medical centers. We used Medicare Part A claims and enrollment records of a 5% nationally random sample of elderly Medicare beneficiaries from 1983 to 1985 to estimate how patient age and sex affected perioperative mortality and 1- and 2-year survival rates among elderly patients undergoing a colon resection procedure for colon cancer. Among the 5,586 individuals in our data set, the overall perioperative mortality rate was 5.0%, ranging from 3.3% in beneficiaries 66 to 69 years of age to 9.3% in those 85 years of age and older. Men had a 31% higher perioperative mortality rate than women (5.8% versus 4.4%, p <0.05). The overall postoperative survival rates at 1 and 2 years were 72% and 63%, respectively, decreasing with increasing age, but were similar in men and women. This analysis provides age- and sex-specific estimates of outcomes following surgery for elderly patients with colon cancer that are more precise and have more potential for generalization than those that were available previously.

关键词：年龄因素结肠切除术/死亡率结肠切除术/统计学和数值数据结肠肿瘤/死亡率结肠肿瘤/外科学置信区间预期寿命 Logistic模型医学审核 MedicareA部回归分析性别因素存活率治疗结果美国/流行病学老年人老年人 80以上女(雌)性人类男(雄)性

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Fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease

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WORLD JOURNAL OF SURGERY 2000年第1期24卷 125-129页

作者： Yamamoto, T Keighley, MRB Queen Elizabeth Hosp Dept Surg Birmingham B15 2TH W Midlands England

The aim of this study was to examine the fate of the rectum and ileal recurrence rates after total colectomy for Crohn's disease. One hundred thirty patients who underwent total colectomy between 1970 and 1997 were reviewed;65 patients underwent end ileostomy with an oversewn rectal stump (TC+I) kind 65 had ileorectal anastomosis (IRA). Patients treated by TC+I had significantly more rectal involvement (93%) than those having IRA (43%) (p < 0,0001), The incidence of ileal disease at the time of colectomy was similar (TC+I 34% versus IRA 32%;p = 0.99). Rectal recurrence requiring proctectomy was significantly more common after TC+I (51%) than after IRA(26%) (p = 0.01), whereas ileal recurrence requiring resection was significantly more common after IRA (45%) than after TC+I (18%) (p = 0.002). Using Kaplan-Meier methods, the 10-year cumulative probability of proctectomy was significantly higher after TC+I than IRA (58% versus 22%;p = 0.0001), whereas the ill-year cumulative probability of ileal resection was significantly higher after IRA than TC+I (37% versus 18%;p = 0.03). In conclusion, the proctectomy rate is higher after colectomy and ileostomy probably due to a higher incidence of preoperative rectal involvement. By contrast, the ileal recurrence rate is higher after colectomy and IRA.

关键词：吻合术外科/方法吻合术外科/统计学和数值数据卡方分布结肠切除术/方法结肠切除术/统计学和数值数据 Crohn病/外科学随访研究回肠/外科学手术后并发症/流行病学直肠/外科学复发回顾性研究统计学非参数青少年成年人老年人女(雌)性人类男(雄)性中年人

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