Predictors For Postoperative Complications After Laparoscopic Colorectomy For Colorectal Cancer By Retrospective Cohort Study

Colorectal cancer(CRC) is a common malignant tumor in China, the incidence rate is increasing in recent years and ranked as the second most common cancer. Surgery with combined therapy is the standard treatment for CRC. Since the first case of laparoscopic right hemicolectomy was performed in1991, laparoscopic surgery has been constantly developed for the treatment of CRC.A number of prospective randomized studies show that laparoscopic colorectomy (LCT) for CRC could achieve not only less trauma,better cosmetic effect and faster recovery but also safety and comparable oncologic outcomes, compared with the traditional surgery. Thus, LCT has play an increasingly important role in CRC treatment. However, minimally invasive surgery does not mean that the operative-related complications is tiny as well. More and more experts concern the issues caused by the complications after LCT.The risk factors for predicting the complications after LCT is of importance in the CRC research field. At present, the rate of postoperative complications after LC-T for the treatment of CRC varied a lot and few studies reported the the extent of severity on the complications. In our study, we applied the Clavien-dindo classification system to grade complications, and analyzed the relationship between the incidence of complications and the factors of perioperative period by retrospective cohort study and investigated the risk factors of moderate or severe postoperative complications in CRC patients after LCT. Through the above researched, we could have a preliminary estimate objectively about complications during preoperative perior and reduce the incidence of complications.Objective To investigate the risk factors of postoperative complications after laparoscopic colorectomy for colorectal cancerMethods a total of806patients underwent laparoscopic colorectomy for colorectal cancer from2003to2012in the Nanfang Hospital of Southern medical university were retrospectively reviewed. Patients’ clinical data included demographic data, preoperative concurrent diseases,complications, tumor staging, time of surgery, intraoperative blood loss, postoperative complications and so on. The Clavien-dindo classification system was adopted to grade complications. Logistic regression model was used to determine the risk factors for moderate or severe complications.Results1. Of806cases,487cases were male., Mean age was57.73±13.1. Except for21cases were converted to open surgery, the remaining785cases were completed in laparoscopic procedure.2.Median of operation time was166min (52-454min),and median of intraoperative blood loss was50ml (5-2000ml);3.Postoperative complicatons rate was13.4%, According to the Clavien-Dindo system for postoperative complications classification, postoperative complications of grade Ⅰ、Ⅱ、Ⅲ-a、Ⅲ-b,Ⅳ-a were3.7%、10.9%、1.2%、2%、1.6%, respectively. No complications of Ⅳ-b and Ⅴ were observed.4. Multivariate analysis showed that concurrent pulmonary disease (OR=3.89, 95%CI:1.557～9.723,P=0.004) and intraoperative blood loss≥100ml(OR=2.052,95%CI:1.208～2.486, P=0.008) are the independent risk factors of the moderate or severe complications after laparoscopic colorectomy for colorectal cancer.ConclusionsOur study shows that concurrent pulmonary disease and intraoperative blood loss are associated with an elevated risk of moderate or severe complcations after laparoscopic colorectomy for colorectal cancer, suggesting that controlling preoperative concurrent pulmonary disease, the strict operation indications and precise operation, controlling intraoperative blood loss may potentially reduce the risk of moderate or severe postoperative complications.