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Yuu et al. Laparoscopic surgery for psychotic

often present with complicated medical and psychiatric specified in Table 1. Schizophrenia (n = 17) and
problems . Such patients have difficulty coping with dementing disorders (n = 6) were overrepresented. The
[7]
the diagnosis and treatment of cancer, and they may median disease period of all psychiatric disorders was
ignore warning signs and symptoms of the disease 24 years (range: 0-58 years). Twenty-four patients had
because of their cognitive impairment , which can received psychotropic drugs orally, including at least
[8]
result in riskier treatments having to be performed. one major psychotropic drug (a functional category of
neuroleptic drugs that are helpful in treating psychosis
Herein, we report the surgical outcomes of psychiatric and have the capacity to ameliorate thought disorders),
patients with colorectal cancer. The aim of this study and 19 had received minor psychotropic drugs (a drug
was to evaluate the surgical feasibility and safety of that reduces anxiety). Psychotropic drugs include
LS. Thus, we compared the operative, pathological, benzodiazepine derivatives and a few less widely
and functional outcomes of LS with those of OS in this used non-benzodiazepines, such as meprobamate
patient population. and hydroxyzine hydrochloride). Seven patients had
received epileptic agents, and 5 had taken donepezil.
METHODS All patients had received at least one psychiatric
medication. All patients were involuntarily admitted to
A retrospective analysis was performed using a the hospital; i.e. they were subjected to hospitalization
colorectal cancer database. Information in the database for medical care and protection under Sections 1, 3,
was prospectively collected between April 2013 and and 4 of the Mental Health and Welfare Act in Japan [10] .
September 2015 at the Tokyo Metropolitan Matsuzawa At our hospital, patients with psychiatric problems can
Hospital. Thirty-one patients underwent LS or OS for be referred to psychiatrists at any time postoperatively,
primary colorectal cancer. We investigated the short- and 24-h psychiatric care is available, which enabled us
term outcomes of laparoscopic colorectal resection to manage the study subjects in an unlocked surgical
compared with OS in psychiatric patients with colorectal ward.
cancer. All patients examined in this study were eligible
for either approach. OS was performed between April Surgical technique
2013 and March 2014, and LS was started in April 2014. No patients underwent mechanical and chemical
The exclusion criterion for LS was acute surgery due to bowel preparation. All laparoscopic and open
perforative peritonitis. No patients were excluded from procedures were performed by a single gastrointestinal
the present analysis because palliative surgery was surgical team. Laparoscopic procedures started to be
performed or advanced disease was present. Informed performed in April 2014. The exclusion criterion for LS
consent was obtained from all patients or their relatives was acute surgery due to perforative peritonitis. All
or guardians. This study was approved by the institutional patients were operated on under general anesthesia.
review board of Tokyo Metropolitan Matsuzawa Hospital All laparoscopic and open procedures were performed
(approval number: 28). according to the relevant guidelines [11] , and the extent
of the resection was the same in both groups. All
Preoperative evaluations included colonoscopy laparoscopic procedures were performed by the same
with biopsy; chest, abdominal, and pelvic computed surgeon, who was a proven expert, as defined by the
tomography examinations; and magnetic resonance Japan Society for Endoscopic Surgery. Conversion
imaging. Patients were staged using the Japanese from LS to OS was allowed at the surgeon’s discretion
Society for Cancer of the Colon and Rectum (eighth to ensure the patient’s safety or because of technical
edition) . An American Society of Anesthesiologists difficulties, the presence of associated conditions, or
[9]
(ASA) grade was assigned to each patient by an findings of advanced disease or inadequate oncological
anesthetist preoperatively. margins. Reconstruction was performed with a
hand-sewn straight colonic anastomosis or stapled
All patients were involuntarily admitted to the hospital anastomosis. A temporary ileostomy was created in
because of anosodiaphoria. They were diagnosed as selected patients. The same postoperative care was
having colorectal cancer, but it was difficult to admit them provided in all patients.
to a general hospital for treatment other than psychiatric
care. Tokyo Metropolitan Matsuzawa Hospital is one of Outcome assessment
the biggest hospitals in Tokyo that has a surgical and Postoperatively, the bowel motility recovery time,
psychiatry department. washout period, and length of the hospitalization period
were assessed. The washout period was defined as
Psychiatric disorders the duration of days between the surgery and start of
Details of the patients’ psychiatric disorders are psychiatric medicine postoperatively. Postoperative

174 Mini-invasive Surgery ¦ Volume 1 ¦ December 28, 2017