Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study.

PURPOSE: The laparoscopic approach to rectal cancer is still a controversial procedure. A comparative cohort study was conducted to assess short-term results of laparoscopic restorative mesorectal excision. METHODS: From January 1998 to December 2000, laparotomy was performed on all primary rectal cancer undergoing radical excision. From January 2002 to September 2004, all cases about to undergo radical excision were considered for laparoscopy. Patients with fixed tumor or T4, indications for synchronous hepatectomy, emergencies, and medical contraindications were not included. The study was based on the intention-to-treat principle. RESULTS: Short-term outcome was compared between the laparoscopy group (n=104) and the laparotomy group (n=68). Demographic, general and tumor data, and rates of preoperative irradiation were comparable, as were surgical procedures and perioperative management. Hospital mortality (1 and 2.9 percent, P=0.33) and three-month overall morbidity (43.3 and 48.5 percent, P=0.49) were comparable between laparoscopy and laparotomy groups. Surgical complication rates were comparable (39.3 and 35.5 percent, P=0.58), but a significantly lower medical complication rate was observed in laparoscopy patients (8.7 and 20.6 percent, P=0.025), mainly because this group had fewer respiratory complications. Hospital stay was shorter in laparoscopy patients (10 and 14 days, P<0.001). Oncologic quality criteria were comparable, in terms of number of lymph nodes, lateral and distal margins, and delivery of postoperative chemotherapy. CONCLUSIONS: The laparoscopic approach to restorative mesorectal excision for cancer does not increase postoperative morbidity or reduce oncologic quality. Our results suggest that the short-term outcome is probably improved with this procedure.

Development and validation of a perioperative satisfaction questionnaire.

BACKGROUND: Satisfaction is considered a valuable measure of outcome of healthcare processes. Only a few anesthesia-related validated questionnaires are reported. Because their scope is restricted to specific clinical contexts, their use remains limited. The objective of the current study was to develop and validate a self-reported questionnaire, Evaluation du Vecu de l'Anesthesie Generale (EVAN-G), assessing the satisfaction of the perioperative period surrounding general anesthesia. METHODS: Development of the EVAN-G questionnaire comprised a phase of item generation and a phase of psychometric validation. The patient sample was generated to be proportionally matched to the population of patients undergoing general anesthesia in France. The structure of the questionnaire was identified studying interitem, item-dimension, and interdimension correlations and factor analyses. Data were concurrently gathered to assess external validity. The discriminant validity was determined by comparison of scores across well known patient groups. Reliability was assessed by computation of Cronbach alpha coefficients and by test-retest. RESULTS: Eight hundred seventy-four patients were recruited in eight anesthesia departments. The EVAN-G includes 26 items; six specific scores and one global index score are available. Correlations between EVAN-G scores and other concurrent measures supported convergent validity. The EVAN-G correlated poorly with age, American Society of Anesthesiologists physical status, total anesthesia time, and number of previous anesthesias. Significantly higher satisfaction was reported by patients older than 65 yr, belonging to the laryngeal mask group. Reliability and reproducibility were shown. CONCLUSION: The EVAN-G adds important information oriented toward patients' perceptions. The authors' approach provides a novel, valid, and reliable tool that may be used in anesthesia practice.