Abstract
Introduction
Small bowel obstruction, infertility, and chronic abdominal pain are generally mentioned as the main clinical consequences of adhesion formation after abdominal surgery1,2. Difficulties experienced during reoperation are less pronounced consequences, but seem to have a huge impact. A large retrospective cohort study3 revealed that adhesiolysis was significantly associated with risk of sepsis (odds ratio (OR) 5.12), intra-abdominal complications (OR 3.46), and wound infection (OR 2.45). There is very limited literature on intraoperative assessment of adhesions and modifiable risk factors, especially in patients with locally advanced colonic cancer4,5. Laparoscopic surgery seems to reduce the burden of adhesions, but is considered a relative contraindication in T4 disease6. The aim of this study was to compare the presence and severity of adhesions after laparoscopic or open resection of locally advanced colonic cancer at 18-month re-exploration of the abdomen in the COLOPEC randomized trial, which was designed to assess adjuvant hyperthermic intraperitoneal chemotherapy7.
Methods
Detailed methods of this study are provided in Appendix S1. Outcomes of the present study were presence and severity (classified from 0 to 10 according to Dowson and colleagues6) of adhesions at 18 months. Severe adhesions were defined as those with a Dowson score exceeding 6. The Zühlke score classifies adhesions as: 1, filmy adhesions; 2, stronger adhesions requiring sharp dissection; 3, dense vascularized adhesions requiring sharp dissection; and 4, extreme dense vascularized adhesions with high risk of organ damage during dissection8.
Results
Figure 1 shows patient enrolment, allocation, and follow-up in the COLOPEC trial and how the inclusion of patients in the present analysis was derived. In short, 204 patients with resectable primary c/pT4 N0–2 M0 or perforated colonic tumours were randomized and evaluated by laparoscopy at 18 months. The primary tumour resection was laparoscopic in 75, open in 43, and converted in 10 patients (Table 1). Adhesions were present in 36 patients (48 per cent) in the laparoscopic group and 46 (89 per cent) in the open group (Table 2). Adhesions after open primary resection were more often extensive (42 versus 11 per cent), more often had a Zühlke score of 3 or higher (51 versus 14 per cent), and had a significantly higher mean Dowson adhesion severity score (5.3 versus 2.4). Serosal tears occurred during adhesiolysis in five patients after open primary resection, but not after initial laparoscopic resection.
Small bowel obstruction, infertility, and chronic abdominal pain are generally mentioned as the main clinical consequences of adhesion formation after abdominal surgery1,2. Difficulties experienced during reoperation are less pronounced consequences, but seem to have a huge impact. A large retrospective cohort study3 revealed that adhesiolysis was significantly associated with risk of sepsis (odds ratio (OR) 5.12), intra-abdominal complications (OR 3.46), and wound infection (OR 2.45). There is very limited literature on intraoperative assessment of adhesions and modifiable risk factors, especially in patients with locally advanced colonic cancer4,5. Laparoscopic surgery seems to reduce the burden of adhesions, but is considered a relative contraindication in T4 disease6. The aim of this study was to compare the presence and severity of adhesions after laparoscopic or open resection of locally advanced colonic cancer at 18-month re-exploration of the abdomen in the COLOPEC randomized trial, which was designed to assess adjuvant hyperthermic intraperitoneal chemotherapy7.
Methods
Detailed methods of this study are provided in Appendix S1. Outcomes of the present study were presence and severity (classified from 0 to 10 according to Dowson and colleagues6) of adhesions at 18 months. Severe adhesions were defined as those with a Dowson score exceeding 6. The Zühlke score classifies adhesions as: 1, filmy adhesions; 2, stronger adhesions requiring sharp dissection; 3, dense vascularized adhesions requiring sharp dissection; and 4, extreme dense vascularized adhesions with high risk of organ damage during dissection8.
Results
Figure 1 shows patient enrolment, allocation, and follow-up in the COLOPEC trial and how the inclusion of patients in the present analysis was derived. In short, 204 patients with resectable primary c/pT4 N0–2 M0 or perforated colonic tumours were randomized and evaluated by laparoscopy at 18 months. The primary tumour resection was laparoscopic in 75, open in 43, and converted in 10 patients (Table 1). Adhesions were present in 36 patients (48 per cent) in the laparoscopic group and 46 (89 per cent) in the open group (Table 2). Adhesions after open primary resection were more often extensive (42 versus 11 per cent), more often had a Zühlke score of 3 or higher (51 versus 14 per cent), and had a significantly higher mean Dowson adhesion severity score (5.3 versus 2.4). Serosal tears occurred during adhesiolysis in five patients after open primary resection, but not after initial laparoscopic resection.
| Original language | English |
|---|---|
| Pages (from-to) | 315-318 |
| Journal | The British journal of surgery |
| Volume | 109 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2022 |
| Externally published | Yes |
Free keywords
- Colonic Neoplasms/pathology
- Humans
- Neoplasm Staging
- Peritoneal Neoplasms
- Tissue Adhesions
