Analysis of risk factors for perioperative severe complications after laparoscopic radical resection of colorectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SHI Shuai , XU Boyu , MA Wenxing , QIN Haoyuan , LIU Sida , JIANG Jiantong ,  DUAN Xianglong

The Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, P. R. China;

Corresponding author：

DUAN Xianglong, Email: duanxl@21cn.com

Keywords：

colorectal cancer; laparoscopic radical resection; Clavien-Dindo classification; severe complication; risk factor

DOI：

10.7507/1007-9424.202205060

Video：

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Objective To explore the risk factors of perioperative severe complications (Clavien-Dindo grade Ⅲ and above) after laparoscopic radical resection of colorectal cancer (CRC). Methods The clinicopathologic data of CRC patients who met the inclusion and exclusion criteria treated in the Shaanxi Provincial People’s Hospital from January 2018 to December 2020 were retrospectively analyzed. The univariate and multivariate logistic analyses were used to explore the risk factors of perioperative severe complications after the laparoscopic radical resection of CRC. Results Atotal of 170 eligible patients were included in this study, and the postoperative complications occurred in 45 patients, 24 of whom were severe complications. The univariate analysis results showed that the age (P<0.001), body mass index (BMI, P=0.047), age adjusted Charlson complication index (aCCI) score (P=0.002), American Association of Anesthesiologists (ASA) classification (P<0.001), prognostic nutritional index (PNI, P=0.011), preoperative anemia (P=0.011), operation numbers of surgeon (P=0.003), and operation time (P=0.026) were related to the perioperative severe complications in the patients underwent the laparoscopic radical resection of CRC. The statistic indexes of univariate analysis (P<0.05) combined with indexes of clinical significance were included in the multivariate analysis, the results showed that the ASA classification Ⅲ– Ⅳ (OR=3.536, P=0.027), BMI ≥25 kg/m² (OR=3.228, P=0.031), preoperative anemia (OR=2.876, P=0.049), operation numbers of surgeon <300 (OR=0.324, P=0.046), and the operation time ≥300 min (OR=3.480, P=0.020) increased the probability of perioperative severe complications in the patients underwent the laparoscopic radical resection of CRC. Conclusions The results of this study suggest that clinicians should pay attention to the perioperative management of patients with CRC, such as adequately evaluating the preoperative status of patients by ASA classification, PNI, and aCCI to adjust the malnutrition of patients; after operation, the patients with BMI ≥25 kg/m² and operation time more than 300 min should be paid more attention. At the same time, the surgeon should continuously accumulate the operation numbers and improve the operation proficiency so as to reduce the occurrence of perioperative severe complications after laparoscopic radical resection of CRC.

Citation： SHI Shuai, XU Boyu, MA Wenxing, QIN Haoyuan, LIU Sida, JIANG Jiantong, DUAN Xianglong. Analysis of risk factors for perioperative severe complications after laparoscopic radical resection of colorectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(12): 1591-1596. doi: 10.7507/1007-9424.202205060 Copy

1.	Carli F, Bousquet-Dion G, Awasthi R, et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial. JAMA Surg, 2020, 155(3): 233-242.
2.	Lawler J, Choynowski M, Bailey K, et al. Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery. BJS Open, 2020, 4(5): 737-747.
3.	Tian Y, Xu B, Yu G, et al. Age-adjusted Charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection. Oncotarget, 2017, 8(13): 20794-20801.
4.	肖琪, 普彦淞, 段宝军, 等. 胃肠道恶性肿瘤手术患者不同营养筛查与评估工具的研究现状. 中华普通外科学文献(电子版), 2021, 15(2): 157-160.
5.	Chen L, Bai P, Kong X, et al. Prognostic nutritional index (PNI) in patients with breast cancer treated with neoadjuvant chemotherapy as a useful prognostic indicator. Front Cell Dev Biol, 2021, 9: 656741. doi: 10.3389/fcell.2021.656741.
6.	Zhou S, Feng Q, Zhang J, et al. High-grade postoperative complications affect survival outcomes of patients with colorectal cancer peritoneal metastases treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. BMC Cancer, 2021, 21(1): 41. doi: 10.1186/s12885-020-07756-7.
7.	Hashimoto S, Hamada K, Sumida Y, et al. Postoperative complications predict long-term outcome after curative resection for perforated colorectal cancer. In Vivo, 2021, 35(1): 555-561.
8.	Sofić A, Rašić I, Halilović E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications? Med Glas (Zenica), 2021, 18(2): 450-455.
9.	裴炜, 周思成, 梁建伟, 等. 80岁及以上结直肠癌患者术后严重并发症的危险因素分析. 中华胃肠外科杂志, 2020, 23(7): 695-700.
10.	陈竟文, 常文举, 张之远, 等. 机器人中低位直肠癌保肛术后吻合口漏发生的影响因素分析. 中华胃肠外科杂志, 2020, 23(4): 364-369.
11.	高铭, 戴刚, 蔡卓玮, 等. 结直肠癌术后并发症的风险预测模型. 中国普外基础与临床杂志, 2021, 28(2): 252-255.
12.	Wang D, Zhang J, Bai Z, et al. Associations of postoperative complications assessed by Clavien-Dindo classification and comprehensive complication index with long-term overall survival in elderly patients after radical CRC resection. Clin Interv Aging, 2020, 15: 1939-1949.
13.	He AQ, Li CQ, Zhang Q, et al. Visceral-to-subcutaneous fat ratio is a potential predictor of postoperative complications in colorectal cancer. Med Sci Monit, 2021, 27: e930329. doi: 10.12659/MSM.930329.
14.	张敏, 刘思达, 刁敏, 等. 体质量指数对腹腔镜结直肠癌手术结果的影响. 腹部外科, 2020, 33(3): 223-226.
15.	刘勇, 刘桂娜, 龚佳祺, 等. 结直肠癌患者的BMI会影响术后住院时间—基于DACCA的真实世界数据研究. 中国普外基础与临床杂志, 2021, 28(11): 1486-1493.
16.	Yang SJ, Li HR, Zhang WH, et al. Visceral fat area (VFA) superior to BMI for predicting postoperative complications after radical gastrectomy: a prospective cohort study. J Gastrointest Surg, 2020, 24(6): 1298-1306.
17.	阎龙, 王新平, 刘宏斌, 等. 内脏脂肪与胃癌发病及治疗关系的研究进展. 中国普外基础与临床杂志, 2021, 28(12): 1655-1660.
18.	Baastrup NN, Christensen JK, Jensen KK, et al. Visceral obesity and short-term outcomes after laparoscopic rectal cancer resection. Surg Endosc, 2020, 34(1): 177-185.
19.	康文越, 马鹤, 潘振祥. 腹腔镜二氧化碳气腹对老年人重要器官的影响. 中国老年学杂志, 2013, 33(15): 3807-3809.
20.	Kim J, Shim SH, Oh IK, et al. Preoperative hypoalbuminemia is a risk factor for 30-day morbidity after gynecological malignancy surgery. Obstet Gynecol Sci, 2015, 58(5): 359-367.
21.	Duraes LC, Stocchi L, Steele SR, et al. The relationship between clavien-dindo morbidity classification and oncologic outcomes after colorectal cancer resection. Ann Surg Oncol, 2018, 25(1): 188-196.
22.	Tomioka K, Murakami M, Fujimori A, et al. Risk factors for transumbilical wound complications in laparoscopic gastric and colorectal surgery. In Vivo, 2017, 31(5): 943-948.
23.	Hirahara N, Tajima Y, Fujii Y, et al. Prognostic nutritional index as a predictor of survival in resectable gastric cancer patients with normal preoperative serum carcinoembryonic antigen levels: a propensity score matching analysis. BMC Cancer, 2018, 18(1): 285. doi: 10.1186/s12885-018-4201-4.
24.	吴建军, 朱初明, 晏江, 等. 预后营养指数在结直肠肿瘤术后手术部位感染的预测作用. 肠外与肠内营养, 2017, 24(5): 287-291.
25.	Hare GMT, Mazer CD. Anemia: perioperative risk and treatment opportunity. Anesthesiology, 2021, 135(3): 520-530.
26.	Sequeira SB, Quinlan ND, Althoff AD, et al. Iron deficiency anemia is associated with increased early postoperative surgical and medical complications following total hip arthroplasty. J Arthroplasty, 2021, 36(3): 1023-1028.
27.	Kedir H, Miller R, Syed F, et al. Association between anemia and postoperative complications in infants undergoing pyloromyotomy. J Pediatr Surg, 2019, 54(10): 2075-2079.
28.	张文明, 陆春雷, 李科军, 等. 胃癌患者术前贫血与术后并发症及预后的相关性. 现代肿瘤医学, 2021, 29(7): 1183-1187.
29.	Pallan A, Dedelaite M, Mirajkar N, et al. Postoperative complications of colorectal cancer. Clin Radiol, 2021, 76(12): 896-907.
30.	Tsai KY, Kiu KT, Huang MT, et al. The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital. Asian J Surg, 2016, 39(1): 34-40.

1. Carli F, Bousquet-Dion G, Awasthi R, et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial. JAMA Surg, 2020, 155(3): 233-242.
2. Lawler J, Choynowski M, Bailey K, et al. Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery. BJS Open, 2020, 4(5): 737-747.
3. Tian Y, Xu B, Yu G, et al. Age-adjusted Charlson comorbidity index score as predictor of prolonged postoperative ileus in patients with colorectal cancer who underwent surgical resection. Oncotarget, 2017, 8(13): 20794-20801.
4. 肖琪, 普彦淞, 段宝军, 等. 胃肠道恶性肿瘤手术患者不同营养筛查与评估工具的研究现状. 中华普通外科学文献(电子版), 2021, 15(2): 157-160.
5. Chen L, Bai P, Kong X, et al. Prognostic nutritional index (PNI) in patients with breast cancer treated with neoadjuvant chemotherapy as a useful prognostic indicator. Front Cell Dev Biol, 2021, 9: 656741. doi: 10.3389/fcell.2021.656741.
6. Zhou S, Feng Q, Zhang J, et al. High-grade postoperative complications affect survival outcomes of patients with colorectal cancer peritoneal metastases treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. BMC Cancer, 2021, 21(1): 41. doi: 10.1186/s12885-020-07756-7.
7. Hashimoto S, Hamada K, Sumida Y, et al. Postoperative complications predict long-term outcome after curative resection for perforated colorectal cancer. In Vivo, 2021, 35(1): 555-561.
8. Sofić A, Rašić I, Halilović E, et al. Is preoperative hypoproteinemia associated with colorectal cancer stage and postoperative complications? Med Glas (Zenica), 2021, 18(2): 450-455.
9. 裴炜, 周思成, 梁建伟, 等. 80岁及以上结直肠癌患者术后严重并发症的危险因素分析. 中华胃肠外科杂志, 2020, 23(7): 695-700.
10. 陈竟文, 常文举, 张之远, 等. 机器人中低位直肠癌保肛术后吻合口漏发生的影响因素分析. 中华胃肠外科杂志, 2020, 23(4): 364-369.
11. 高铭, 戴刚, 蔡卓玮, 等. 结直肠癌术后并发症的风险预测模型. 中国普外基础与临床杂志, 2021, 28(2): 252-255.
12. Wang D, Zhang J, Bai Z, et al. Associations of postoperative complications assessed by Clavien-Dindo classification and comprehensive complication index with long-term overall survival in elderly patients after radical CRC resection. Clin Interv Aging, 2020, 15: 1939-1949.
13. He AQ, Li CQ, Zhang Q, et al. Visceral-to-subcutaneous fat ratio is a potential predictor of postoperative complications in colorectal cancer. Med Sci Monit, 2021, 27: e930329. doi: 10.12659/MSM.930329.
14. 张敏, 刘思达, 刁敏, 等. 体质量指数对腹腔镜结直肠癌手术结果的影响. 腹部外科, 2020, 33(3): 223-226.
15. 刘勇, 刘桂娜, 龚佳祺, 等. 结直肠癌患者的BMI会影响术后住院时间—基于DACCA的真实世界数据研究. 中国普外基础与临床杂志, 2021, 28(11): 1486-1493.
16. Yang SJ, Li HR, Zhang WH, et al. Visceral fat area (VFA) superior to BMI for predicting postoperative complications after radical gastrectomy: a prospective cohort study. J Gastrointest Surg, 2020, 24(6): 1298-1306.
17. 阎龙, 王新平, 刘宏斌, 等. 内脏脂肪与胃癌发病及治疗关系的研究进展. 中国普外基础与临床杂志, 2021, 28(12): 1655-1660.
18. Baastrup NN, Christensen JK, Jensen KK, et al. Visceral obesity and short-term outcomes after laparoscopic rectal cancer resection. Surg Endosc, 2020, 34(1): 177-185.
19. 康文越, 马鹤, 潘振祥. 腹腔镜二氧化碳气腹对老年人重要器官的影响. 中国老年学杂志, 2013, 33(15): 3807-3809.
20. Kim J, Shim SH, Oh IK, et al. Preoperative hypoalbuminemia is a risk factor for 30-day morbidity after gynecological malignancy surgery. Obstet Gynecol Sci, 2015, 58(5): 359-367.
21. Duraes LC, Stocchi L, Steele SR, et al. The relationship between clavien-dindo morbidity classification and oncologic outcomes after colorectal cancer resection. Ann Surg Oncol, 2018, 25(1): 188-196.
22. Tomioka K, Murakami M, Fujimori A, et al. Risk factors for transumbilical wound complications in laparoscopic gastric and colorectal surgery. In Vivo, 2017, 31(5): 943-948.
23. Hirahara N, Tajima Y, Fujii Y, et al. Prognostic nutritional index as a predictor of survival in resectable gastric cancer patients with normal preoperative serum carcinoembryonic antigen levels: a propensity score matching analysis. BMC Cancer, 2018, 18(1): 285. doi: 10.1186/s12885-018-4201-4.
24. 吴建军, 朱初明, 晏江, 等. 预后营养指数在结直肠肿瘤术后手术部位感染的预测作用. 肠外与肠内营养, 2017, 24(5): 287-291.
25. Hare GMT, Mazer CD. Anemia: perioperative risk and treatment opportunity. Anesthesiology, 2021, 135(3): 520-530.
26. Sequeira SB, Quinlan ND, Althoff AD, et al. Iron deficiency anemia is associated with increased early postoperative surgical and medical complications following total hip arthroplasty. J Arthroplasty, 2021, 36(3): 1023-1028.
27. Kedir H, Miller R, Syed F, et al. Association between anemia and postoperative complications in infants undergoing pyloromyotomy. J Pediatr Surg, 2019, 54(10): 2075-2079.
28. 张文明, 陆春雷, 李科军, 等. 胃癌患者术前贫血与术后并发症及预后的相关性. 现代肿瘤医学, 2021, 29(7): 1183-1187.
29. Pallan A, Dedelaite M, Mirajkar N, et al. Postoperative complications of colorectal cancer. Clin Radiol, 2021, 76(12): 896-907.
30. Tsai KY, Kiu KT, Huang MT, et al. The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital. Asian J Surg, 2016, 39(1): 34-40.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of risk factors for perioperative severe complications after laparoscopic radical resection of colorectal cancer

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