Risk Factors Of Severe Postoperative Complications And Prolonged Hospital Stay After Laparoscopic Surgery For Rectal Cancer

Part 1 Risk factors for severe complications after laparoscopic surgery for T3 or T4 rectal cancer for Chinese patients:experience from a single centerObjective Patients with rectal cancer are usually at advanced stage with or beyond serosa invasion in China.Severe complications after laparoscopic rectal surgery leads to prolonged hospitalization and high medical cost.This study aimed to explore risk factors for severe complications after laparoscopic surgery of T3 or T4 rectal cancer.Methods A total of 287 patients diagnosed with T3 or T4 rectal cancer were enrolled from the department of gastrointestinal surgery of Anhui Provincial Hospital from February 2012 to February 2017.Univariate analysis and multivariable logistic regression model were used to analyze the risk factors for severe complications(Clavien-Dindo grade ? III)after laparoscopic surgery.Results Eighteen patients(6.25%)occurred severe complications;15 patients were categorized as Clavien-Dindo grade III and 3 patients were Clavien-Dindo grade IV.Univariate analysis showed that male gender,high preoperative white blood cells(WBC),diabetes mellitus,pulmonary dysfunction and tumor distance from anus were associated with increased risk of severe complications after laparoscopic surgery for rectal cancer.Multivariate analysis showed that preoperative WBC ? 6.9 × 109/L(OR(95%CI):5.54(1.58-19.45),P=0.008),diabetes mellitus(OR=13.07(3.31-51.67),P=0.000)and pulmonary dysfunction(OR=7.75(1.69-35.63),P=0.008)were independent risk factors for postoperative severe complications.Conclusions Preoperative high white blood cells,diabetes mellitus and pulmonary dysfunction were independent risk factors for severe complications after laparoscopic surgery for T3 or T4 rectal cancer.Part 2 Analysis of risk factors for prolonged hospital stay in laparoscopic surgery for rectal cancerObjective To investigate the risk factors for prolonged hospitalization of laparoscopic surgery in patients with rectal cancer.Methods A retrospective analysis of 464 patients undergoing laparoscopic rectal cancer radical surgery from February 2012 to February 2017 in the First Affiliated Hospital of the University of Science and Technology of China(Anhui Provincial Hospital).Univariate analysis and multivariate logistic regression models were used to analyze the risk factors for prolonged hospital stay.Results Univariate analysis showed that the gender,age,history of diabetes,ASA classification and severity of postoperative complications were associated with prolonged hospital stay for laparoscopic rectal cancer(P<0.05).Multivariate logistic regression analysis showed that age(OR=2.14,P=0.01),ASA classification ?3(OR=2.30,P=0.03)and postoperative complications(OR=5.62,P<0.001)were hospitalized for laparoscopic rectal cancer.Independent risk factors for prolonged time.Conclusion Age,ASA classification and grading of complications are independent risk factors for prolonged hospital stay in laparoscopic surgery for rectal cancer.