Conversion of laparoscopic colon resection does not affect survival in colon cancer.

BACKGROUND: Laparoscopic and open resections of colon cancer are considered oncologically equivalent treatment methods. Conversion of laparoscopic procedures, however, was associated with decreased survival in colon cancer patients in the only prior study examining this question. We conducted this study to evaluate the effect of conversion on survival. METHODS: A series of consecutive patients treated with laparoscopic resection of colorectal cancer (n = 174) in the period 1998-2003 was evaluated retrospectively. Median follow-up was 51 months with a minimum of 3 years. RESULTS: There was no statistically significant difference in all-cause mortality between laparoscopically completed and converted groups (22/143, 15.4% versus 8/31, 25.8%; OR 1.9, p = 0.164). Kaplan-Meier survival analysis did not show any survival difference between the two groups (p = 0.266). CONCLUSIONS: The results of our study suggest there is no survival difference in patients requiring conversion of laparoscopic resection indicated for colorectal cancer. Further examination of this question is warranted to determine whether laparoscopic resection of colorectal cancer should be offered to all patients, including those at high risk for conversion.

The influence of prior abdominal operations on conversion and complication rates in laparoscopic colorectal surgery.

BACKGROUND AND OBJECTIVES: A history of a prior abdominal operation is common among patients presenting for laparoscopic colorectal surgery, and its impact on conversion and complication rates has been insufficiently studied. This study compares the conversion rates of patients with and without a prior abdominal operation (PAO). METHODS: We analyzed 1000 consecutive laparoscopic colorectal resection cases. RESULTS: Complete data on past surgical history were available on 820 of 1000 patients. The overall conversion rate was 14.8% (122/820). A history of PAO was present in 347 patients (42.3%). These patients experienced a higher conversion rate compared with non-PAO patients (68/347, 19.6% versus 54/473, 11.4%; P < 0.001; OR 1.9). Patients with PAO had a significantly higher rate of inadvertent enterotomy (5/347, 1.4% vs. 1/473, 0.2%; P = 0.04; OR 6.9), a higher incidence of postoperative ileus (23/347, 6.6% vs 14/473% 3.0; P = 0.012; OR 2.3), and higher reoperative rates (8/347, 2.3% vs 1/473, 0.2%; P = 0.006; OR 11.1). The incidence of other complications and mortality (total 6/820, 0.7%) was similar regardless of PAO status. CONCLUSION: Having a prior abdominal operation represents a risk factor for conversion in laparoscopic colon and rectal surgery. The incidence of a successfully completed laparoscopic operation, however, remains high in previously operated on patients.

Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma.

BACKGROUND: A large population of patients on oral anticoagulants is exposed to the risk of traumatic brain injury (TBI). Effects of age and anticoagulation on TBI outcomes need to be assessed separately. METHODS: Retrospective analysis of consecutive series of TBI patients (age 18 years and older) in a suburban teaching hospital. RESULTS: A total of 1,493 adult blunt head trauma patients between January 2001 and May 2005 were analyzed. Of these, 159 patients were warfarin-anticoagulated at the time of trauma. The mortality in anticoagulated patients was statistically significantly higher than in the control group (38/159, 23.9% vs. 66/1,334, 4.9%; p < 0.001; odds ratio 6.0). Mortality of patients over 70 years of age was significantly higher than in the younger population (p < 0.001). Both mortality and the occurrence of intracranial hemorrhage (ICH) after head trauma were significantly increased with higher INR (Cochran's linear trend p < 0.001), especially with INR over 4.0 (mortality 50%, risk of ICH 75%). Preinjury warfarin anticoagulation and age were found to be predictive of survival in a binary logistic regression model (92.5% correct prediction, p = 0.027). Addition of Injury Severity Score and initial Glasgow Coma Score to this model only modestly improved its predictive performance (95.4% correct prediction, p < 0.001). CONCLUSIONS: Both age and warfarin anticoagulation are independent predictors of mortality after blunt TBI. Warfarin anticoagulation carries a six-fold increase in TBI mortality. Age over 70 years and excessive anticoagulation are associated with higher mortality, as well.