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

doi:10.3877/cma.j.issn.2095-3224.2023.04.005

Abstract

Abstract:

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.

Key words: Rectal neoplasms, Intersphincteric resection, Clavien-dindo classification, Complication

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]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(04): 296-302.

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URL: https://zhjzcjbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3224.2023.04.005

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Figures/Tables 5

临床基本资料	Ⅱ级及以上并发症患者（n=84）	无Ⅱ级及以上并发症患者（n=422）
性别
男	64	250
女	20	172
年龄（岁）
＞60	38	217
≤60	46	205
BMI（kg/m²）
＞25.0	33	145
≤25.0	51	277
nCRT
是	18	40
否	66	382
糖尿病病史
是	10	57
否	74	365
保留左结肠动脉
是	41	230
否	43	192
血红蛋白（g/L）
＜120	14	51
≥120	70	371
血清白蛋白（g/L）
＞35.0	4	18
≥35.0	80	404
CEA（ng/mL）
＞5.0	20	116
≤ $5.0$	64	306
出血量（mL）
＞100	11	38
≤1 $00$	73	384
手术时间（min）
＞180	46	160
≤ $180$	38	262
ASA分级
3	10	94
1~2	74	328
预防性回肠造口
是	71	356
否	13	66
肿瘤至肛缘距离（cm）
≤4.0	72	314
4~5	12	108
吻合口至肛缘距离（cm）
≤3.0	77	401
＞3.0	7	21
大体分型
隆起型	33	145
溃疡型	51	277
分化
低分化	14	70
高-中分化	70	352
肿瘤大小（mm）
＞40	27	139
≤ $40$	57	283
T分期
T3	48	234
T0~2	36	168
N分期
N+	30	137
N-	54	285
脉管癌栓
是	18	82
否	66	340
神经侵犯
是	15	72
否	69	350
TNM分期
Ⅲ~Ⅳ	32	151
Ⅰ~Ⅱ	52	271

临床基本资料	Ⅱ级及以上并发症患者（n=84）	无Ⅱ级及以上并发症患者（n=422）
性别
男	64	250
女	20	172
年龄（岁）
＞60	38	217
≤60	46	205
BMI（kg/m²）
＞25.0	33	145
≤25.0	51	277
nCRT
是	18	40
否	66	382
糖尿病病史
是	10	57
否	74	365
保留左结肠动脉
是	41	230
否	43	192
血红蛋白（g/L）
＜120	14	51
≥120	70	371
血清白蛋白（g/L）
＞35.0	4	18
≥35.0	80	404
CEA（ng/mL）
＞5.0	20	116
≤ $5.0$	64	306
出血量（mL）
＞100	11	38
≤1 $00$	73	384
手术时间（min）
＞180	46	160
≤ $180$	38	262
ASA分级
3	10	94
1~2	74	328
预防性回肠造口
是	71	356
否	13	66
肿瘤至肛缘距离（cm）
≤4.0	72	314
4~5	12	108
吻合口至肛缘距离（cm）
≤3.0	77	401
＞3.0	7	21
大体分型
隆起型	33	145
溃疡型	51	277
分化
低分化	14	70
高-中分化	70	352
肿瘤大小（mm）
＞40	27	139
≤ $40$	57	283
T分期
T3	48	234
T0~2	36	168
N分期
N+	30	137
N-	54	285
脉管癌栓
是	18	82
否	66	340
神经侵犯
是	15	72
否	69	350
TNM分期
Ⅲ~Ⅳ	32	151
Ⅰ~Ⅱ	52	271

并发症类别	例数	Clavien-Dindo分级
并发症类别	例数	Ⅱ	Ⅲa	Ⅲb	Ⅳ	Ⅴ
吻合口漏	40	28	3	7		2
肠梗阻	19	15	4
吻合口狭窄	7	4	1	2
直肠阴道瘘	5	4		1
淋巴漏	3	3
盆腔脓肿	2	2
腹腔出血	2		1	1
心肌梗死	2				2
输尿管损伤	1			1
造口旁疝嵌顿	1			1
直肠尿道瘘	1	1
肺部感染	1					1

	单因素分析
	HR	95.0% CI	P值
性别（男/女）	2.202	1.285~3.772	0.004
年龄（＞60/≤60岁）	1.281	0.801~2.051	0.301
BMI（＞25/≤25 kg/m²）	1.236	0.764~2.001	0.388
术前nCRT（是/否）	2.605	1.409~4.816	0.003
糖尿病病史（是/否）	1.156	0.564~2.367	0.693
保留LCA（是/否）	0.792	0.495~1.265	0.329
血红蛋白（＜120/≥120 g/L）	1.455	0.764~2.771	0.254
血清白蛋白（＜35/≥35 g/L）	1.122	0.370~3.404	0.839
CEA（＞5/≤5 ng/mL）	1.260	0.729~2.178	0.408
出血量（＞100/≤100 mL）	1.523	0.744~3.116	0.250
手术时间（＞180/≤180 mins）	2.136	1.319~3.457	0.002
预防性回肠造口（是/否）	1.013	0.530~1.934	0.970
肿瘤至肛缘距离（≤4 cm/4 cm~5 cm）	2.064	1.078~3.949	0.029
吻合口至肛缘距离（≤3 cm/＞3 cm）	1.736	0.713~4.225	0.224
N分期（N+/N0）	1.156	0.708~1.888	0.563
分型（隆起/溃疡型）	1.232	0.761~1.994	0.397
分化（低分化/中高分化）	1.000	0.533~1.875	1.000
肿瘤最大径（＞40 mm/≤40 mm）	1.048	0.635~1.730	0.854
脉管侵犯（是/否）	1.131	0.637~2.008	0.675
神经侵犯（是/否）	1.057	0.572~1.951	0.860
ASA分级（3/1~2）	1.307	0.714~2.392	0.385
（y）pT分期（3/1~2）	1.061	0.658~1.709	0.808
TNM（Ⅲ~Ⅳ/Ⅰ~Ⅱ）	1.104	0.681~1.791	0.687

	B	标准误差	瓦尔德	P值	Exp（B）	95%置信区间
性别（男/女）	0.855	0.291	8.641	0.003	2.352	1.330	4.160
术前nCRT（是/否）	0.730	0.330	4.893	0.027	2.076	1.087	3.965
手术时间（＞/≤180 min）	0.645	0.252	6.538	0.011	1.907	1.163	3.127
肿瘤至肛缘距离（≤4 cm/4 cm~5 cm）	0.823	0.350	5.530	0.019	2.278	1.147	4.523

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