Risk Factor Analysis of Postoperative Complications After Robotic Rectal Cancer Surgery
Risk Factor Analysis of Postoperative Complications After Robotic Rectal Cancer Surgery
复制标题
DOI：
10.1007/s00268-011-1270-9
复制
发表时间：
2011-11-01
影响因子：
2.6
通讯作者：
Lee, Kang Young
中科院分区：
文献类型：
--
作者：
Kang, Jeonghyun;Min, Byung Soh;Lee, Kang Young
背景：机器人系统已成为直肠癌微创手术的新模式。然而，对机器人直肠癌手术(RRS)后并发症的危险因素的分析一直很有限。方法对2006年6月至2010年10月间389例RRS患者的临床资料进行统计分析。最常见的并发症是吻合口漏(7.0%)，其次是排尿困难、盆腔脓肿和肠梗阻。多因素分析显示，男性、既往腹部手术史和肿瘤级别较低(风险比[HR]=1.8，95%可信区间[CI]=1.0~3.1，p=0.041；HR=2.3，95%CI=1.2~4.6，p=0.012；HR=1.9，95%CI=1.1~3.3，p=0.020)是术后并发症的危险因素。在盆腔脓毒症并发症方面，肿瘤水平较低、肿瘤体积较大和术前放化疗仍是多因素分析中具有统计学意义的变量(HR=2.695%CI=1.1~6.1，P=0.029；HR=2.7，95%CI=1.1~6.1，P=0.017；HR=2.9，95%CI=1.3~6.5，P=0.007)。术后并发症的发生率不受不同的腹腔镜手术经验和机器人手术技术的影响。结论外科医生应更加谨慎地对待这些患者因素，以实现机器人直肠切除术的最大效益。
Background The robotic system has been adopted as the new modality for minimally invasive surgery for rectal cancer. However, analysis of risk factors for complications after robotic rectal cancer surgery (RRS) has been limited. This study aimed to identify the risk factors for complications after RRS.Methods The records of 389 consecutive patients who underwent RRS between June 2006 and October 2010 were retrieved from our prospectively collected database.Results The overall complication rate was 19%. The most common complication was anastomotic leakage (7.0%), followed by voiding difficulty, intrapelvic abscess, and ileus/obstruction. Multivariate analysis revealed the following as risk factors for postoperative complications: male gender, history of previous abdominal surgery, and lower tumor level (hazard ratio [HR] = 1.8, 95% confidence interval [CI] = 1.0-3.1, p = 0.041; HR = 2.3; 95% CI = 1.2-4.6, p = 0.012; and HR = 1.9, 95% CI = 1.1-3.3, p = 0.020, respectively). With regard to pelvic septic complications, lower tumor level, large tumor size, and preoperative chemoradiation remained variables that retained their statistical significance in multivariate analysis (HR = 2.6, 95% CI = 1.1-6.1, p = 0.029; HR = 2.7, 95% CI = 1.1-6.1, p = 0.017; HR = 2.9, 95% CI = 1.3-6.5, p = 0.007, respectively). The rate of postoperative complications was not influenced by the difference in laparoscopic surgery experience or the technique of robotic surgery.Conclusion Surgeons should be more cautious with these patient factors to optimize the benefits of robotic rectal resection.