Analysis of postoperative complications and their related factors after laparoscopic radical surgery in rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Zuoliang , XIE Xuehong , TIAN Hongpeng , LI Lifa , HOU Huafang , ZHANG Guangjun ,  ZHOU Tong

Department of Gastrointestinal Surgery, Institute of Hepatobiliary, Pancreas and Intestinal Disease, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding?author：

ZHOU Tong, Email: zhoutong0088@163.com

Keywords：

rectal cancer; laparoscope; radical surgery; postoperative complications

DOI：

10.7507/1007-9424.201804087

Video：

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Objective To investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.Methods The clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.Results There were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).Conclusion Gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.

Citation： LIU Zuoliang, XIE Xuehong, TIAN Hongpeng, LI Lifa, HOU Huafang, ZHANG Guangjun, ZHOU Tong. Analysis of postoperative complications and their related factors after laparoscopic radical surgery in rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(12): 1482-1486. doi: 10.7507/1007-9424.201804087 Copy

1.	Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
2.	Zhao JK, Chen NZ, Zheng JB, et al. Laparoscopic versus open surgery for rectal cancer: Results of a systematic review and meta-analysis on clinical efficacy. Mol Clin Oncol, 2014, 2(6): 1097-1102.
3.	Ohtani H, Tamamori Y, Azuma T, et al. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. J Gastrointest Surg, 2011, 15(8): 1375-1385.
4.	覃華波, 謝明顥, 練磊, 等. 直腸癌根治術: 腹腔鏡與開腹手術后并發癥的比較. 中國普外基礎與臨床雜志, 2015, 22(5): 530-534.
5.	池畔. 腹腔鏡低位直腸癌根治術. 中國實用外科雜志, 2011, 31(9): 867-870.
6.	池畔, 陳致奮. 直腸癌術后吻合口漏的診斷與治療進展. 中華消化外科雜志, 2014, 13(7): 584-590.
7.	Bosma E, Pullens MJ, de Vries J, et al. The impact of complications on quality of life following colorectal surgery: a prospective cohort study to evaluate the Clavien-Dindo classification system. Colorectal Dis, 2016, 18(6): 594-602.
8.	張尚鑫, 李永翔. 腹腔鏡結直腸癌手術研究新進展. 中國實用外科雜志, 2012, 32(8): 685-687.
9.	何二松, 姚清深, 周騰賢. 腹腔鏡直腸癌根治術的可行性、安全性及腫瘤根治性分析. 腹腔鏡外科雜志, 2014, 19(7): 518-523.
10.	徐佳, 黃世鋒. 腹腔鏡直腸癌手術與開腹直腸癌手術的療效對比研究. 結直腸肛門外科, 2012, 18(4): 236-239.
11.	栗明, 李琳, 鄭瑞, 等. 腹腔鏡直腸癌根治術與傳統開腹直腸癌手術的療效對比. 昆明醫科大學學報, 2015, 36(5): 145-147.
12.	Roxburgh CS, Guillem JG. Outcomes of open vs laparoscopic rectal cancer resection. JAMA Oncol, 2017, 3(1): 115-116.
13.	張貴聰, 羅光輝, 宋濤. 腹腔鏡直腸癌手術的常見并發癥及其防治措施. 中國普通外科雜志, 2015, 24(11): 1613-1617.
14.	Park JS, Choi GS, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4): 665-671.
15.	張展志, 肖萌萌, 李雁, 等. 腹腔鏡直腸癌保肛手術后吻合口瘺的危險因素與對策. 中華腫瘤防治雜志, 2016, 23(1): 40-44.
16.	Qu H, Liu Y, Bi DS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc, 2015, 29(12): 3608-3617.
17.	Kang CY, Halabi WJ, Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg, 2013, 148(1): 65-71.
18.	Akiyoshi T, Ueno M, Fukunaga Y, et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Am J Surg, 2011, 202(3): 259-264.
19.	孔杰, 甘從存, 徐士杰, 等. 中低位直腸癌全直腸系膜切除術后吻合口瘺的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(2): 210-213.
20.	Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg, 2010, 4(1): 5.
21.	劉林, 王海江, 趙澤亮, 等. 腹腔鏡直腸癌根治術后并發癥及其相關因素分析. 中國實用外科雜志, 2013, 33(8): 683-686.
22.	Tortorelli AP, Alfieri S, Sanchez AM, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg, 2015, 81(1): 41-47.
23.	Ma Y, Yang Z, Qin H, et al. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol, 2011, 28(4): 925-933.
24.	Akiyoshi T, Ueno M, Fukunaga Y, et al. Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech, 2011, 21(6): 409-414.
25.	Choi DH, Hwang JK, Ko YT, et al. Risk factors for anastomotic leakage after laparoscopic rectal resection. J Korean Soc Coloproctol, 2010, 26(4): 265-273.
26.	Park IJ, Choi GS, Lim KH, et al. Laparoscopic resection of extraperitoneal rectal cancer: a comparative nalysis with open resection. Surg Endosc, 2009, 23(8): 1818-1824.
27.	易先武, 黃君. 肛管減壓預防直腸癌吻合口瘺的臨床觀察. 海南醫學, 2012, 23(17): 67-68.
28.	朱曉明, 樓征, 龔海峰, 等. 具有開放手術經驗外科醫師腹腔鏡直腸癌根治術學習曲線研究. 中國實用外科雜志, 2016, 36(5): 566-568.
29.	Kayano H, Okuda J, Tanaka K, et al. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc, 2011, 25(9): 2972-2979.

1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3): 144-150.
2. Zhao JK, Chen NZ, Zheng JB, et al. Laparoscopic versus open surgery for rectal cancer: Results of a systematic review and meta-analysis on clinical efficacy. Mol Clin Oncol, 2014, 2(6): 1097-1102.
3. Ohtani H, Tamamori Y, Azuma T, et al. A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. J Gastrointest Surg, 2011, 15(8): 1375-1385.
4. 覃華波, 謝明顥, 練磊, 等. 直腸癌根治術: 腹腔鏡與開腹手術后并發癥的比較. 中國普外基礎與臨床雜志, 2015, 22(5): 530-534.
5. 池畔. 腹腔鏡低位直腸癌根治術. 中國實用外科雜志, 2011, 31(9): 867-870.
6. 池畔, 陳致奮. 直腸癌術后吻合口漏的診斷與治療進展. 中華消化外科雜志, 2014, 13(7): 584-590.
7. Bosma E, Pullens MJ, de Vries J, et al. The impact of complications on quality of life following colorectal surgery: a prospective cohort study to evaluate the Clavien-Dindo classification system. Colorectal Dis, 2016, 18(6): 594-602.
8. 張尚鑫, 李永翔. 腹腔鏡結直腸癌手術研究新進展. 中國實用外科雜志, 2012, 32(8): 685-687.
9. 何二松, 姚清深, 周騰賢. 腹腔鏡直腸癌根治術的可行性、安全性及腫瘤根治性分析. 腹腔鏡外科雜志, 2014, 19(7): 518-523.
10. 徐佳, 黃世鋒. 腹腔鏡直腸癌手術與開腹直腸癌手術的療效對比研究. 結直腸肛門外科, 2012, 18(4): 236-239.
11. 栗明, 李琳, 鄭瑞, 等. 腹腔鏡直腸癌根治術與傳統開腹直腸癌手術的療效對比. 昆明醫科大學學報, 2015, 36(5): 145-147.
12. Roxburgh CS, Guillem JG. Outcomes of open vs laparoscopic rectal cancer resection. JAMA Oncol, 2017, 3(1): 115-116.
13. 張貴聰, 羅光輝, 宋濤. 腹腔鏡直腸癌手術的常見并發癥及其防治措施. 中國普通外科雜志, 2015, 24(11): 1613-1617.
14. Park JS, Choi GS, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4): 665-671.
15. 張展志, 肖萌萌, 李雁, 等. 腹腔鏡直腸癌保肛手術后吻合口瘺的危險因素與對策. 中華腫瘤防治雜志, 2016, 23(1): 40-44.
16. Qu H, Liu Y, Bi DS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc, 2015, 29(12): 3608-3617.
17. Kang CY, Halabi WJ, Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg, 2013, 148(1): 65-71.
18. Akiyoshi T, Ueno M, Fukunaga Y, et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Am J Surg, 2011, 202(3): 259-264.
19. 孔杰, 甘從存, 徐士杰, 等. 中低位直腸癌全直腸系膜切除術后吻合口瘺的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(2): 210-213.
20. Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg, 2010, 4(1): 5.
21. 劉林, 王海江, 趙澤亮, 等. 腹腔鏡直腸癌根治術后并發癥及其相關因素分析. 中國實用外科雜志, 2013, 33(8): 683-686.
22. Tortorelli AP, Alfieri S, Sanchez AM, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg, 2015, 81(1): 41-47.
23. Ma Y, Yang Z, Qin H, et al. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol, 2011, 28(4): 925-933.
24. Akiyoshi T, Ueno M, Fukunaga Y, et al. Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech, 2011, 21(6): 409-414.
25. Choi DH, Hwang JK, Ko YT, et al. Risk factors for anastomotic leakage after laparoscopic rectal resection. J Korean Soc Coloproctol, 2010, 26(4): 265-273.
26. Park IJ, Choi GS, Lim KH, et al. Laparoscopic resection of extraperitoneal rectal cancer: a comparative nalysis with open resection. Surg Endosc, 2009, 23(8): 1818-1824.
27. 易先武, 黃君. 肛管減壓預防直腸癌吻合口瘺的臨床觀察. 海南醫學, 2012, 23(17): 67-68.
28. 朱曉明, 樓征, 龔海峰, 等. 具有開放手術經驗外科醫師腹腔鏡直腸癌根治術學習曲線研究. 中國實用外科雜志, 2016, 36(5): 566-568.
29. Kayano H, Okuda J, Tanaka K, et al. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc, 2011, 25(9): 2972-2979.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of postoperative complications and their related factors after laparoscopic radical surgery in rectal cancer

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