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.	覃华波, 谢明颢, 练磊, 等. 直肠癌根治术: 腹腔镜与开腹手术后并发症的比较. 中国普外基础与临床杂志, 2015, 22(5): 530-534.
5.	池畔. 腹腔镜低位直肠癌根治术. 中国实用外科杂志, 2011, 31(9): 867-870.
6.	池畔, 陈致奋. 直肠癌术后吻合口漏的诊断与治疗进展. 中华消化外科杂志, 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.	张尚鑫, 李永翔. 腹腔镜结直肠癌手术研究新进展. 中国实用外科杂志, 2012, 32(8): 685-687.
9.	何二松, 姚清深, 周腾贤. 腹腔镜直肠癌根治术的可行性、安全性及肿瘤根治性分析. 腹腔镜外科杂志, 2014, 19(7): 518-523.
10.	徐佳, 黄世锋. 腹腔镜直肠癌手术与开腹直肠癌手术的疗效对比研究. 结直肠肛门外科, 2012, 18(4): 236-239.
11.	栗明, 李琳, 郑瑞, 等. 腹腔镜直肠癌根治术与传统开腹直肠癌手术的疗效对比. 昆明医科大学学报, 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.	张贵聪, 罗光辉, 宋涛. 腹腔镜直肠癌手术的常见并发症及其防治措施. 中国普通外科杂志, 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.	张展志, 肖萌萌, 李雁, 等. 腹腔镜直肠癌保肛手术后吻合口瘘的危险因素与对策. 中华肿瘤防治杂志, 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, 甘从存, 徐士杰, 等. 中低位直肠癌全直肠系膜切除术后吻合口瘘的危险因素分析. 中国普外基础与临床杂志, 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.	刘林, 王海江, 赵泽亮, 等. 腹腔镜直肠癌根治术后并发症及其相关因素分析. 中国实用外科杂志, 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, 黄君. 肛管减压预防直肠癌吻合口瘘的临床观察. 海南医学, 2012, 23(17): 67-68.
28.	朱晓明, 楼征, 龚海峰, 等. 具有开放手术经验外科医师腹腔镜直肠癌根治术学习曲线研究. 中国实用外科杂志, 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. 覃华波, 谢明颢, 练磊, 等. 直肠癌根治术: 腹腔镜与开腹手术后并发症的比较. 中国普外基础与临床杂志, 2015, 22(5): 530-534.
5. 池畔. 腹腔镜低位直肠癌根治术. 中国实用外科杂志, 2011, 31(9): 867-870.
6. 池畔, 陈致奋. 直肠癌术后吻合口漏的诊断与治疗进展. 中华消化外科杂志, 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. 张尚鑫, 李永翔. 腹腔镜结直肠癌手术研究新进展. 中国实用外科杂志, 2012, 32(8): 685-687.
9. 何二松, 姚清深, 周腾贤. 腹腔镜直肠癌根治术的可行性、安全性及肿瘤根治性分析. 腹腔镜外科杂志, 2014, 19(7): 518-523.
10. 徐佳, 黄世锋. 腹腔镜直肠癌手术与开腹直肠癌手术的疗效对比研究. 结直肠肛门外科, 2012, 18(4): 236-239.
11. 栗明, 李琳, 郑瑞, 等. 腹腔镜直肠癌根治术与传统开腹直肠癌手术的疗效对比. 昆明医科大学学报, 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. 张贵聪, 罗光辉, 宋涛. 腹腔镜直肠癌手术的常见并发症及其防治措施. 中国普通外科杂志, 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. 张展志, 肖萌萌, 李雁, 等. 腹腔镜直肠癌保肛手术后吻合口瘘的危险因素与对策. 中华肿瘤防治杂志, 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, 甘从存, 徐士杰, 等. 中低位直肠癌全直肠系膜切除术后吻合口瘘的危险因素分析. 中国普外基础与临床杂志, 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. 刘林, 王海江, 赵泽亮, 等. 腹腔镜直肠癌根治术后并发症及其相关因素分析. 中国实用外科杂志, 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, 黄君. 肛管减压预防直肠癌吻合口瘘的临床观察. 海南医学, 2012, 23(17): 67-68.
28. 朱晓明, 楼征, 龚海峰, 等. 具有开放手术经验外科医师腹腔镜直肠癌根治术学习曲线研究. 中国实用外科杂志, 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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