Clinical Analysis Of Postoperative Complications In Gastric Cancer(With783Cases Of Case Analysis)

Objective:To conduct a retrospective analysis of cases,causes and riskfactors of recent studies of postoperative complications of gastric explore therisk factors of gastric postoperative complications,choose reasonableprecautions for the prevention of gastric cancer postoperative complicationsprovide theoretical and clinical basis.Methods:Clinical data collected11,727cases of gastric cancer patientsfrom1963.12to2012.12during the Fourth Hospital of Hebei MedicalUniversity after surgery,including gender,age,history of cardiovasculardisease,diabetes mellitus,history of abdominal surgery,preoperative nutritionalstatus (anemia and low protein),the nature of surgery,surgicalapproach,combined organ,intraoperative blood transfusion after surgery,tumorlocation,tumor size,lymph node metastasis,invasion depth,postoperative TNMstage,consistent manner,such as thoracotomy and laparotomy18relevantfactors,to establish a database,analyzed retrospectively,causes and risk factorsof postoperative complications of gastric recent studies,the applicationprogram SPSS17.0statistical description of the data and statistical analysis,P<0.05statistically significant tips.Results:1Postoperative complications after surgical treatment of11,727cases of patients in this study had783cases,the rate was6.68%.2In this study,783cases of gastric cancer patients with postoperativecomplications,including postoperative bleeding in105patients,the rate was0.90%,72patients wound complications,the rate was0.61%,99cases ofpulmonary complications occurred rate of0.84%,208cases of patients withgastrointestinal obstruction,the rate was1.77%,172patients withgastrointestinal fistula,the rate was1.47%,162cases of patients with pleuraleffusion,the rate was1.38%,venous thrombosis12patients,12patients with cardiac complications,three cases of MODS patients,3patients with delayedgastric emptying.3Relationship with postoperative bleeding risk factorsDifferent tumor sites(χ2=18.954,P=0.001),tumor size different(χ2=4.981,P=0.026),thoracotomy or laparotomy(χ2=5.883,P=0.016),differentanastomosis(χ2=19.601,P=0.000),different surgical methods (χ2=27.129,P=0.000) between the probability of occurrence of postoperative bleedingwith significant difference.Gender(χ2=0.142,P=0.707),Age(χ2=0.807,P=0.369),preoperative lowprotein(χ2=0.009,P=0.924),history of cardiovascular disease (χ2=0.307,P=0.579),abdominal surgery(χ2=0.494,P=0.482), preoperative anemia(χ2=4.162,P=0.125),TNM staging(χ2=4.677,P=0.322),tumor invasion depth(χ2=8.493,P=0.131),lymph node metastasis(χ2=0.349,P=0.555),whetherradical surgery(χ2=0.494,P=0.482),presence or absence of combined organresection(χ2=0.076,P=0.782) and other factors of postoperative bleeding theprobability of no significant statistical difference.For statistical significance(P<0.05)univariate logistic regression analysisperformed,the test found that manual anastomosis(OR=1.658),tumordiameter≥5cm(OR=1.537),total gastrectomy(OR=1.276) significantlyincreased the incidence of postoperative bleeding.4Relationship with wound complications risk factorsProbability of occurrence of wound complications in different agegroups(χ2=9.585,P=0.002),presence or absence of previous history ofcardiopulmonary disease(χ2=12.677,P=0.000),whether the merger history ofdiabetes(χ2=6.907,P=0.009),lymph node There were significant differencesbetween the transfer(χ2=28.655,P=0.000),thoracotomy or laparotomy(χ2=4.552,P=0.033),presence or absence of combined organ resection(χ2=6.642,P=0.010) and other factors.The probability of occurrence of postoperative wound complications indifferent gender(χ2=0.2.155,P=0.142),preoperative low protein (χ2=0.017,P=0.895), abdominal surgery(χ2=0.251, P=0.617), preoperative anemia (χ2=3.462,P=0.177),TNM staging(χ2=7.877,P=0.096),tumor invasion depth(χ2=5.033,P=0.412),tumor location(χ2=6.556,P=0.161),tumor size (χ2=0.119,P=0.730),whether radical surgery(χ2=0.526,P=0.468),no statisticallysignificant difference between the surgical approach(χ2=5.617,P=0.230) andother factors.To have a statistically significant(P<0.05)univariate logistic regressionanalysis performed,the test found that cardiopulmonary disease history(OR=2.402),combined organ resection surgery(OR=1.936),diabetes mellitus(OR=2.148),laparotomy(OR=1.702) can significantly increase the incidenceof wound complications.5Relationship with the risk factors for pulmonary complicationsPulmonary complications in different age groups(χ2=20.326,P=0.000),previous history of cardiovascular disease(χ2=4.987,P=0.026),presence orabsence of preoperative anemia(χ2=6.588,P=0.037), different TNM staging(χ2=16.528,P=0.002),different tumor sites(χ2=35.372,P=0.001),differentsurgical methods(χ2=19.611,P=0.001),between different anastomosis(χ2=9.304,P=0.010) and other factors probability of occurrence is different, theresults were statistically significant.Postoperative pulmonary complications associated with different gender(χ2=0.092,P=0.762),preoperative low protein(χ2=0.752, P=0.386), abdominalsurgery(χ2=0.097,P=0.756),smoking history(χ2=1.614,P=0.204),tumorinvasion depth(χ2=5.483,P=0.360), tumor size(χ2=1.232,P=0.167),lymph nodemetastasis(χ2=0.197,P=0.658), whether radical surgery(χ2=0.538,P=0.463),thoracotomy or laparotomy(χ2=0.300,P=0.584),presence or absence ofcombined organ resection(χ2=2.050,P=0.152), blood transfusion after surgery(χ2=0.071,P=0.788) and other factors showed no statistical difference.To have a statistically significant(P<0.05) univariate logistic regressionanalysis performed,the test found that cardiopulmonary diseasehistory(OR=1.536),preoperative anemia(OR=1.245) and TNM stage(IVstage)(OR=1.311)can significantly increase the incidence of pulmonarycomplications. 6Relations with gastrointestinal obstruction risk factorsχ2analysis found that the incidence of gastrointestinal obstruction andabdominal surgery(χ2=36.425,P=0.000), different tumor sites (χ2=56.558,P=0.000),thoracotomy or laparotomy(χ2=79.184,P=0.000), with or withoutcombined organ resection(χ2=5.398,P=0.020), different surgical methods(χ2=81.781,P=0.000), consistent way(χ2=60.911,P=0.000), whether the use ofanti-adhesion surgery agent(χ2=16.115,P=0.000) and other relevant factors, theresults were statistically significant.Probability of postoperative gastrointestinal obstruction occurs in differentgender(χ2=1.281,P=0.258), Age(χ2=3.022,P=0.082), preoperative low protein(χ2=2.811,P=0.094), history of cardiovascular disease(χ2=0.004,P=0.952),preoperative anemia(χ2=0.397,P=0.820),diabetes mellitus(χ2=0.891, P=0.345),TNM staging(χ2=9.279,P=0.054), tumor invasion depth(χ2=9.771,P=0.082),tumor size(χ2=1.664,P=0.197), lymph node metastasis(χ2=0.360,P=0.548),whether radical surgery(χ2=0.017,P=0.895) and other factors not seesignificant difference.To have a statistically significant(P<0.05) univariate logistic regressionanalysis performed,the test found that abdominal surgery(OR=2.054),abdominal(OR=4.455),hand-fit(OR=1.214) and total gastrectomy(OR=1.136)significantly increased the incidence of gastrointestinal obstruction.7Relationship with the fistula tract risk factors.Univariate analysis showed that the incidence of gastrointestinal fistulawith age(χ2=5.061,P=0.024),preoperative anemia(χ2=9.252,P=0.010), diabetesmellitus(χ2=9.211,P=0.002),TNM staging(χ2=17.981,P=0.001),tumor invasiondepth(χ2=24.726,P=0.000),tumor location(χ2=27.915,P=0.000), tumor size(χ2=10.945,P=0.001),thoracotomy or laparotomy(χ2=5.460,P=0.019), presenceor absence of combined organ resection(χ2=69.378,P=0.000),surgicalapproach (χ2=72.759, P=0.000), consistent way (χ2=27.285, P=0.000),intraoperative and postoperative blood transfusion(χ2=13.626,P=0.000) andother relevant factors, the results were statistically significant.Gender(χ2=3.161,P=0.075),preoperative low protein(χ2=1.636,P=0.201), history of cardiovascular disease(χ2=3.002,P=0.083), abdominal surgery(χ2=0.005,P=0.946),lymph node metastasis(χ2=1.033,P=0.309),whetherradical surgery(χ2=1.365,P=0.243) and other factors on the incidence ofpostoperative gastrointestinal fistula no significant impact.To have a statistically significant(P<0.05) univariate logistic regressionanalysis performed,the test found that a history of diabetes(OR=2.096),preoperative anemia(OR=1.181),combined organ resection(OR=2.752),preoperative postoperative transfusion>400ml(OR=1.853),invasion and omentum(OR=1.192), manual anastomosis(OR=1.902) andtumor diameter≥5cm(OR=1.433) significantly increased the incidence ofgastrointestinal fistula.8Pleural effusion relationship with risk factorsUnivariate analysis showed that the incidence of pleural effusion bypreoperative anemia(χ2=12.616,P=0.002), TNM staging (χ2=14.130,P=0.007),tumor invasion depth(χ2=24.173,P=0.000),tumor location(χ2=44.898,P=0.000), tumor size (χ2=16.589,P=0.000), thoracotomy or laparotomy(χ2=16.404, P=0.000), presence or absence of combined organ resection(χ2=20.813,P=0.000),surgical approach(χ2=66.198,P=0.000),intraoperativeand postoperative blood transfusion(χ2=16.601,P=0.000) and other factors, theresults were statistically significant.Gender(χ2=0.209, P=0.647), Age(χ2=1.432, P=0.231),preoperative lowprotein (χ2=2.053,P=0.152), history of cardiovascular disease (χ2=2.066,P=0.151), abdominal surgery(χ2=0.081,P=0.776), diabetes mellitus (χ2=0.179,P=0.451), lymph node metastasis (χ2=0.003,P=0.958), whether radical surgery(χ2=1.253,P=0.263), anastomosis (χ2=2.736, P=0.255) and other factors hadno significant effect on the incidence of postoperative pleural effusion.To have a statistically significant(P<0.05) univariate logistic regressionanalysis performed, the test found that the combined organ resection(OR=2.418),blood transfusion after surgery>400ml(OR=1.459),TNM stagewas stage IV(OR=1.265),preoperative anemia(OR=1.303),tumordiameter≥5cm(OR=1.530) significantly increased the incidence of pleural effusion.9Year after surgery and the occurrence of different incidence differsignificantly（χ2=24.761，P=0.000）.Conclusions:1In this study, patients with postoperative complications in783patients, the incidence rate was6.68%.2In this study,783cases of patients with complications in patients withpostoperative bleeding105cases, the rate was0.90%,72patients woundcomplications, the rate was0.61%,99cases of pulmonary complications, therate was0.84%,208cases of patients with gastrointestinal obstruction, therate was1.77%,172patients with gastrointestinal fistula, the rate was1.47%,162cases of patients with pleural effusion, the rate was1.38%,12patientswith venous thrombosis,12patients with cardiac complications, three cases ofMODS patients,3patients with delayed gastric emptying.3Risk factors of postoperative bleeding: thoracotomy and laparotomy,tumor location, anastomosis, surgical and tumor size, which fit hand, tumordiameter≥5cm, resection can significantly increase total gastrectomy theincidence of postoperative bleeding.4Risk factors for postoperative wound complications:age, history ofcardiovascular disease, diabetes, joint organs, thoracic and abdominal lymphnode metastasis, which have a history of cardiovascular disease, joint surgeryorgan resection, diabetes mellitus, laparotomy can significantly increase theincidence of wound complications.5Risk factors of postoperative pulmonary complications: age, history ofcardiovascular disease, surgical approach, tumor site, TNM stage, anemia,consistent manner, which has a history of cardiopulmonary disease,preoperative anemia and TNM stage (IV stage) can significantly increase theincidence of pulmonary complications.6Risk factors of postoperative gastrointestinal obstruction: abdominalsurgery, visceral, anti-blocking agents, tumor location, thoracotomy andlaparotomy, anastomosis, surgical approach, including abdominal surgeryhistory, open, hand fit and total gastrectomy can significantly increase the incidence of gastrointestinal obstruction.7Risk factors of postoperative gastrointestinal fistula: age, history ofdiabetes, surgical approach, combined organ, intraoperative and postoperativeblood transfusion, tumor location, depth of invasion, TNM stage, anemia,thoracotomy and laparotomy, consistent manner, and tumor size, which has ahistory of diabetes, preoperative anemia, combined organ resection,intraoperative and postoperative transfusion in>400ml, invading the retina,hand fit and tumor diameter≥5cm increase significantly the incidence ofgastrointestinal fistula.8Risk factors of postoperative pleural effusion: surgical approach,combined organ, intraoperative blood transfusion after surgery, tumor location,depth of invasion, TNM stage, anemia, chest and abdominal and tumor size,which combined organ resection, intraoperative blood transfusion aftersurgery>400ml, TNM staging was stage IV, preoperative anemia, tumordiameter≥5cm can significantly increase the incidence of pleural effusion.9In this study, nearly50years of statistics on hospital treatment ofpatients with gastric cancer, and every10years for the statistical analysis ofthe incidence of each stage of the time period of postoperative complications,P<0.05, explain the occurrence of complications increase with time was trend.