Ten-year experience with laparoscopy on a gynecologic oncology service: Analysis of risk factors for complications and conversion to laparotomy Journal Article
| Authors: | Chi, D. S.; Abu-Rustum, N. R.; Sonoda, Y.; Awtrey, C.; Hummer, A.; Venkatraman, E. S.; Franklin, C. C.; Hamilton, F.; Gemignani, M. L.; Barakat, R. R. |
| Article Title: | Ten-year experience with laparoscopy on a gynecologic oncology service: Analysis of risk factors for complications and conversion to laparotomy |
| Abstract: | The purpose of this study was to analyze our initial 10-year experience with laparoscopy and to determine risk factors for complications and conversions to laparotomy for technical difficulty. We reviewed the charts of all laparoscopic procedures from January 1991 through December 2000 and divided the procedures into 4 levels on the basis of the degree of difficulty: level I, diagnostic; level II, procedures on the uterus and/or adnexa; level III, second look operations for malignancy; and level IV, lymphadenectomies/other complex procedures. Complications were graded from 1 (mild) to 5 (death). Standard univariate and multivariate analyses were performed. We identified 1451 evaluable procedures. The number of complications was as follows: grades 1 to 5, 129 complications (9%); grades 3 to 5, 36 complications (2.5%). On multivariate analysis, older age (P =. 03), previous radiation (P =. 03), and malignancy (P =. 006) were associated with an increased risk of complications grades 3 to 5. Complication rates for grades 3 to 5 for patients with malignancy versus benign disease was 4% versus 1%, respectively. Technical difficulty led to conversion to laparotomy in 105 cases (7%). Previous abdominal surgery (P <. 001) significantly increased the rate of conversion to laparotomy; more complex, higher procedure levels were associated with a significant decrease in conversions (P =. 005). Both simple and complex laparoscopic procedures can be performed by a gynecologic oncology service with a low rate of complications and conversions to laparotomy. Older age, malignancy, previous radiation therapy, and previous abdominal surgery were identified as significant risk factors for complications and/or conversion and should be taken into account in patient selection, preoperative counseling, and surgical planning. © 2004 Elsevier Inc. All rights reserved. |
| Keywords: | adolescent; adult; controlled study; human tissue; aged; aged, 80 and over; middle aged; surgical technique; retrospective studies; major clinical study; review; splenectomy; cancer radiotherapy; lymph node dissection; laparoscopy; laparoscopic surgery; laparotomy; salpingooophorectomy; lymphadenectomy; mastectomy; risk factors; risk factor; risk assessment; postoperative complication; genital neoplasms, female; disease severity; cystectomy; medical record; new york city; malignant neoplastic disease; intestine resection; gynecologic surgical procedures; multivariate analysis; age distribution; vaginal hysterectomy; abdominal surgery; second look surgery; gynecologic cancer; uterus; myomectomy; female genital system; complication; uterine tube ligation; humans; human; female; priority journal; gynecologic oncology service; obstetrics and gynecology department, hospital |
| Journal Title: | American Journal of Obstetrics and Gynecology |
| Volume: | 191 |
| Issue: | 4 |
| ISSN: | 0002-9378 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2004-10-01 |
| Start Page: | 1138 |
| End Page: | 1145 |
| Language: | English |
| DOI: | 10.1016/j.ajog.2004.05.004 |
| PROVIDER: | scopus |
| PUBMED: | 15507933 |
| DOI/URL: | |
| Notes: | Am. J. Obstet. Gynecol. -- Cited By (since 1996):31 -- Export Date: 16 June 2014 -- CODEN: AJOGA -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work