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中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (04) : 296 -302. doi: 10.3877/cma.j.issn.2095-3224.2023.04.005

论著

腹腔镜直肠癌经括约肌间切除术后Clavien- Dindo Ⅱ级及以上并发症的危险因素及其对预后的影响
胡刚, 刘军广, 邱文龙, 梅世文, 权继传, 庄孟, 汤坚强(), 王锡山   
  1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
    100034 北京大学第一医院普通外科
  • 收稿日期:2023-03-03 出版日期:2023-08-25
  • 通信作者: 汤坚强
  • 基金资助:
    国家自然科学基金(81903023); 吴阶平医学基金会临床科研专项资助基金课题(320.6750.2021-04-2); 北京自然科学基金面上项目(4232058); 北京自然科学基金海淀前沿项目(L222054); 中国医学科学院肿瘤医院“希望之星”人才项目

Risk factors for Clavien-Dindo Grade Ⅱ and above complications after laparoscopic intersphincteric resection for rectal cancer and its effect on prognosis

Gang Hu, Junguang Liu, Wenlong Qiu, Shiwen Mei, Jichuan Quan, Meng Zhuang, Jianqiang Tang(), Xishan Wang   

  1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    Department of General Surgery, Peking University First Hospital, Beijing 100034, China
  • Received:2023-03-03 Published:2023-08-25
  • Corresponding author: Jianqiang Tang
引用本文:

胡刚, 刘军广, 邱文龙, 梅世文, 权继传, 庄孟, 汤坚强, 王锡山. 腹腔镜直肠癌经括约肌间切除术后Clavien- Dindo Ⅱ级及以上并发症的危险因素及其对预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(04): 296-302.

Gang Hu, Junguang Liu, Wenlong Qiu, Shiwen Mei, Jichuan Quan, Meng Zhuang, Jianqiang Tang, Xishan Wang. Risk factors for Clavien-Dindo Grade Ⅱ and above complications after laparoscopic intersphincteric resection for rectal cancer and its effect on prognosis[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(04): 296-302.

目的

分析腹腔镜直肠癌经括约肌间切除(LISR)术后Clavien-Dindo Ⅱ级及以上并发症的危险因素及其对预后的影响。

方法

回顾性病例对照研究分析一组2012年6月至2021年12月实施的506例LISR患者的临床资料,根据术后是否发生Ⅱ级及以上并发症分为两组,分析影响并发症发生的独立危险因素,并分析此类并发症对患者OS和DFS的影响。

结果

506例患者中共84例发生Ⅱ级及以上并发症,发生率16.6%,单因素分析显示性别、术前是否行nCRT、手术时间以及肿瘤至肛缘距离与LISR术后发生Ⅱ级及以上并发症有关;多因素分析显示男性性别(OR=2.352,95%CI:1.330~4.160,P=0.003)、行nCRT(OR=2.076,95%CI:1.087~3.965,P=0.027)、手术时间>180 mins(OR=1.907,95%CI:1.163~3.127,P=0.011)以及肿瘤至肛缘距离≤4 cm(OR=2.278,95%CI:1.147~4.523,P=0.019)是LISR术后发生Ⅱ级及以上并发症的独立危险因素,但两组之间的3、5年OS和DFS差异无统计学意义。

结论

男性性别、术前nCRT、手术时间>180 mins以及肿瘤至肛缘距离≤4 cm是LISR术后发生Ⅱ级及以上并发症的独立危险因素,但不影响患者的总生存率及无病生存率。

Objective

Analyze the risk factors of Clavien-Dindo grade Ⅱ and above complications after laparoscopic intersphincteric resection (LISR) for rectal cancer and its affect on prognosis.

Methods

A retrospective case-control study was conducted to analyze the clinical data of 506 patients with LISR from June 2012 to December 2021. The patients were divided into two groups according to whether grade Ⅱ or above complications occurred after surgery. Independent risk factors influencing the occurrence of complications were analyzed, and the effects of such complications on OS and DFS were analyzed.

Results

A total of 84 of 506 patients had Grade Ⅱ or above complications, with an incidence rate of 16.6%. Univariate analysis showed that gender, preoperative nCRT, operation time and distance from tumor to anal margin were related to the occurrence of Grade Ⅱ or above complications after LISR. Multivariate analysis showed that male sex (OR=2.352, 95%CI: 1.330~4.160, P=0.003), line nCRT (OR=2.076, 95%CI: 1.087~3.965, P=0.027), operation time >180 mins (OR=1.907, 95%CI: 1.163~3.127, P=0.011) and the distance from tumor to anal margin ≤4 cm (OR=2.278, 95%CI: 1.147~4.523, P=0.019) were independent risk factors for grade Ⅱ and above complications after LISR surgery. However, there was no significant difference in OS and DFS between the two groups at 3 and 5 years.

Conclusions

Male sex, nCRT, operation time >180 mins and distance from tumor to anal margin ≤4 cm are independent risk factors for grade II and above complications after LISR surgery, but the complications does not affect overall survival and disease-free survival.

表1 506例腹腔镜直肠癌经括约肌间切除术患者基本资料(例)
表2 84例腹腔镜直肠癌经括约肌间切除术后Ⅱ级及以上并发症情况(例)
表3 影响直肠癌经括约肌间切除术后Ⅱ级及以上并发症的单因素分析
表4 影响直肠癌经括约肌间切除术后Ⅱ级及以上并发症的多因素分析
图1 Ⅱ级及以上并发症对LISR患者OS及DFS的影响。1A:Ⅱ级及以上并发症对总生存(OS)的影响;1B:Ⅱ级及以上并发症对无病生存(DFS)的影响
[1]
刘佳文, 汤东, 王道荣. 内括约肌切除术在低位直肠癌保肛中的应用[J/CD]. 中华结直肠疾病电子杂志, 2019, 8(6): 622-626.
[2]
Park IJ, Kim JC. Intersphincteric resection for patients with low-lying rectal cancer: oncological and functional outcomes[J]. Ann Coloproctol, 2018, 34(4): 167-174.
[3]
Matthiessen P, Hansson L, Sjödahl R, et al. Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer--occurrence and risk factors[J]. Colorectal Dis, 2010, 12(4): 351-357.
[4]
刘军广, 陈贺凯, 郑利军, 等. 腹腔镜直肠癌超低位前切除术造口回纳后再发吻合口漏危险因素分析[J]. 中国实用外科杂志, 2022, 42(2): 199-205.
[5]
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience[J]. Ann Surg, 2009, 250(2): 187-196.
[6]
Veenhof AA, Engel AF, Van-der-peet DL, et al. Technical difficulty grade score for the laparoscopic approach of rectal cancer: a single institution pilot study[J]. Int J Colorectal Dis, 2008, 23(5): 469-475.
[7]
Targarona EM, Balague C, Pernas JC, et al. Can we predict immediate outcome after laparoscopic rectal surgery? Multivariate analysis of clinical, anatomic, and pathologic features after 3-dimensional reconstruction of the pelvic anatomy[J]. Ann Surg, 2008, 247(4): 642-649.
[8]
Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases[J]. Int J Colorectal Dis, 2009, 24(6): 711-723.
[9]
Nasir ZA, Muhammad HA, Saad UK, et al. A meta-analysis of the role of diverting ileostomy after rectal cancer surgery[J]. Int J Colorectal Dis, 2021, 36(3): 445-455.
[10]
朱晓明, 张卫. 低位直肠癌切除术后影响功能因素分析及对策[J/CD]. 中华结直肠疾病电子杂志, 2019, 8(3): 221-226.
[11]
Yang J, Luo Y, Tian T, et al. Effects of neoadjuvant radiotherapy on postoperative complications in rectal cancer: a meta-analysis[J]. J Oncol, 2022, 5(2022): 8197701.
[12]
Qin QY, Ma TH, Deng YH, et al. Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection: post hoc analysis of a randomized controlled trial[J]. Dis Colon Rectum, 2016, 59(10): 934-942.
[13]
Akasu T, Takawa M, Yamamoto S, et al. Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma[J]. J Gastrointest Surg, 2010, 14(1): 104-111.
[14]
Qu H, Liu Y, Bi DS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis[J]. Surg Endosc, 2015, 29(12): 3608-3617.
[15]
Soo YL, Chang HK, Young JK, et al. Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer[J]. Surg Endosc, 2018, 32(2): 660-666.
[16]
Smith JD, Paty PB, Guillem JG, et al. Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer[J]. Ann Surg, 2012, 256(6): 1034-1038.
[17]
Power C, Coffey JC. Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer[J]. Ann Surg, 2015, 261(3): e74.
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