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Laparoscopic right colectomy vs laparoscopic-assisted colonoscopic polypectomy for endoscopically unresectable polyps: a randomized controlled trial.
- Source :
-
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2016 Nov; Vol. 18 (11), pp. 1050-1056. - Publication Year :
- 2016
-
Abstract
- Aim: A randomized controlled trial (RCT) was conducted to test the null hypothesis that there is no difference in complication rates and length of stay (LOS) between laparoscopic right colectomy (LRC) and laparoscopic-assisted colonoscopic polypectomy (LACP) for endoscopically unresectable polyps of the right colon.<br />Method: A single-centre RCT (NCT01986699) was conducted on patients with polyps of the right colon deemed by the gastroenterologist to be unresectable. Patients underwent a repeat colonoscopy with biopsy by an interventional endoscopist and were allocated to LRC or LACP. Patients with a nonlift sign, dysplasia, adenocarcinoma, inflammatory bowel disease or familial adenomatous polyposis were excluded from the trial. The study was powered to detect a 73% difference in the LOS which required 17 patients in each arm with an α error of 0.05 and a power of 95%.<br />Results: Thirty-four patients were comparable for age (P = 0.919), gender (P = 0.364), body mass index (P = 0.634), American Society of Anesthesiologists class (P = 0.388) and previous abdominal surgery (P = 0.366). There was no significant difference in the preoperative morphology (P = 0.485), location (P = 0.297), size (P = 0.690) or histology of the polyps (P = 0.779). LRC patients experienced a longer operating time (180 vs 90 min; P = 0.001), required more intravenous infusion (3.1 vs 2.0 l; P = 0.025), took significantly longer to pass flatus (2.88 vs 1.44 days; P < 0.001), resumed solid food later (3.94 vs 1.69 days; P < 0.001) and had a longer postoperative LOS (4.94 vs 2.63 days; P < 0.001). Postoperative complications (P = 0.656), readmissions (P = 0.5) and reoperations (P = 0.5) did not differ. Final size (P = 0.339) and histology (P = 0.104) of the polyps did not differ. There were four cancers in the LRC arm. At follow-up colonoscopy with biopsy of the scar in 10 patients at 15.3 months, one patient had recurrence of the polyp at the site of the previous LACP.<br />Conclusion: LACP and LRC had similar complication rates, but LOS was shorter after LACP.<br /> (Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Colon pathology
Colon surgery
Colonic Polyps pathology
Female
Humans
Length of Stay
Male
Middle Aged
Operative Time
Postoperative Complications epidemiology
Postoperative Complications etiology
Treatment Outcome
Colectomy methods
Colonic Polyps surgery
Colonoscopy methods
Laparoscopy methods
Subjects
Details
- Language :
- English
- ISSN :
- 1463-1318
- Volume :
- 18
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
- Publication Type :
- Academic Journal
- Accession number :
- 27038277
- Full Text :
- https://doi.org/10.1111/codi.13346