Risk Factors for Complications following Introduction of Radical Surgery for Colon Cancer: A Consecutive Patient Series
Risk Factors for Complications following Introduction of Radical Surgery for Colon Cancer: A Consecutive Patient Series
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DOI：
10.1177/1457496918798208
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发表时间：
2019-06-01
影响因子：
2.4
通讯作者：
Pfeffer, F.
中科院分区：
文献类型：
--
作者：
Furnes, B.;Storli, K. E.;Pfeffer, F.
背景：直肠癌手术标准化，提高了生存率。结肠癌已经落后了，因此引入了更彻底的手术技术。一种技术是全肠系膜切除术。本文的目的是研究在单一中心引入标准化全肠系膜切除术后的并发症。方法：2007年引入全肠系膜切除术，收集手术前286例患者（2007-2010）的资料。外科医生决定开腹手术还是腹腔镜手术。跟踪信息记录至2015年12月31日。根据改良的Clavien-Dindo分类法对并发症进行分类。结果：并发症发生率47%，严重并发症（III级和IV级）发生率15%。住院死亡率为3.5%。142例（49.7%）采用开放手术。Logistic回归分析显示，贫血（p = 0.001）、开放手术（p < 0.001）、手术时间过长（p < 0.001）是并发症发生的重要因素。多项logistic回归显示，男性（优势比：2.56,95%可信区间：0.98-6.68）、贫血患者（优势比：3.49,95%可信区间：1.27-9.60）、体重指数升高患者（优势比：1.14,95%可信区间：1.02-1.28）和开放手术患者（优势比：9.95,95%可信区间：2.58-38.35）的严重并发症发生率较高。年龄与严重并发症无关。并发症对生存率无显著影响。并发症患者的总生存率（5年）为90%，无并发症患者为92%。结论：引入全肠系膜切除术后的严重并发症是患者依赖的，与开放手术有关。选择腹腔镜手术的患者并发症较少；因此，采用腹腔镜进行全肠系膜切除是合理的。识别这些因素可以改善手术入路的选择和术后患者的安全。
Background: Rectal cancer surgery is standardized, resulting in improved survival. Colon cancer has fallen behind and therefore more radical surgical techniques have been introduced. One technique is complete mesocolic excision. The aim of this article was to study the complications after the introduction of standardized complete mesocolic excision in a single center. Methods: Complete mesocolic excision was introduced in 2007, and data were collected from 286 patients prior to surgery (2007-2010). The surgeon decided on open or laparoscopic surgery. Follow-up information was recorded until 31 December 2015. Complications were classified according to a modified Clavien-Dindo classification. Results: Complications occurred in 47%, severe complications (grade III and IV) in 15%. In-hospital mortality was 3.5%. A total of 142 patients (49.7%) were operated by open surgery. Logistic regression revealed anemia (p = 0.001), open surgery (p < 0.001), and long operating time (p < 0.001) as significant factors for complications in general. Multinomial logistic regression revealed that severe complications occurred more often in males (odds ratio: 2.56; 95% confidence interval: 0.98-6.68), patients with anemia (odds ratio: 3.49; 95% confidence interval: 1.27-9.60), elevated body mass index (odds ratio: 1.14; 95% confidence interval: 1.02-1.28), and in open surgery (odds ratio: 9.95; 95% confidence interval: 2.58-38.35). Age was not associated with severe complications. Survival was not significantly influenced by complications. Overall survival (5 years) was 90% among patients with complications and 92% among those without complications. Conclusion: Severe complications following the introduction of complete mesocolic excision are patient dependent and related to open surgery. Patients selected for laparoscopy had less number of complications; therefore, introducing complete mesocolic excision by laparoscopy is justified. Identification of these factors can improve selection of appropriate surgical approach and postoperative patient safety.