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Type: Journal article
Title: Five year follow-up of a randomized controlled trial on warming and humidification of insufflation gas in laparoscopic colonic surgery--impact on small bowel obstruction and oncologic outcomes
Author: Sammour, T.
Hill, A.G.
Citation: International Surgery, 2015; 100(4):608-616
Publisher: International College of Surgeons
Issue Date: 2015
ISSN: 0020-8868
Statement of
Tarik Sammour, Andrew G. Hill
Abstract: Warming and humidification of insufflation gas has been shown to reduce adhesion formation and tumor implantation in the laboratory setting, but clinical evidence is lacking. We aimed to test the hypothesis that warming and humidification of insufflation CO2 would lead to reduced adhesion formation, and improve oncologic outcomes in laparoscopic colonic surgery. This was a 5-year follow-up of a multicenter, double-blinded, randomized, controlled trial investigating warming and humidification of insufflation gas. The study group received warmed (37 degrees C), humidified (98%) insufflation carbon dioxide, and the control group received standard gas (19 degrees C, 0%). All other aspects of patient care were standardized. Admissions for small bowel obstruction were recorded, as well as whether management was operative or nonoperative. Local and systemic cancer recurrence, 5-year overall survival, and cancer specific survival rates were also recorded. Eighty two patients were randomized, with 41 in each arm. Groups were well matched at baseline. There was no difference between the study and control groups in the rate of clinical small bowel obstruction (5.7% versus 0%, P 0.226); local recurrence (6.5% versus 6.1%, P 1.000); overall survival (85.7% versus 82.1%, P 0.759); or cancer-specific survival (90.3% versus 87.9%, P 1.000). Warming and humidification of insufflation CO2 in laparoscopic colonic surgery does not appear to confer a clinically significant long term benefit in terms of adhesion reduction or oncological outcomes, although a much larger randomized controlled trial (RCT) would be required to confirm this. Trial identifier: NCT00642005; US National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894, USA.
Keywords: Aged Carbon Dioxide/administration & dosage Colonic Diseases/*surgery Double-Blind Method Female Follow-Up Studies Humans Humidity Insufflation/*methods Intestinal Obstruction/*surgery Intestine, Small *Laparoscopy Male Pneumoperitoneum, Artificial Postoperative Complications Survival Rate Temperature Tissue Adhesions/prevention & control Adhesions Colorectal Laparoscopy Small bowel obstruction colectomy humidification
Rights: Copyright © International College of Surgeons. All rights reserved.
DOI: 10.9738/INTSURG-D-14-00210.1
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