Clavien-Dindo classification of complications after complete mesocolic excision in laparoscopic radical resection of right hemicolon cancer and analysis on its influencing factors
10.3760/cma.j.issn.1671-0274.2020.01.009
- VernacularTitle: 腹腔镜右半结肠癌完整结肠系膜切除术后并发症的Clavien-Dindo分级及影响因素分析
- Author:
Minzhe LI
1
;
Kangyue LI
2
;
Jian SHEN
1
;
Dehong XIE
1
Author Information
1. Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
2. Class 2 Grade 2015, Capital Medical University, Beijing 100054, China
- Publication Type:Journal Article
- Keywords:
Colon neoplasms;
Complete mesocolic excision;
Laparoscopy;
Clavien-Dindo Classification;
Multivariate analysis
- From:
Chinese Journal of Gastrointestinal Surgery
2020;23(1):51-55
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the Clavien-Dindo (CD) classification of complications after complete mesocolic excision (CME) in laparoscopic radical resection of right-sided hemicolon cancer and its influencing factors.
Methods:A retrospective case-control study was performed. Inclusion criteria: (1) the adenocarcinoma located at colon from cecum to hepatic flexure; (2) laparoscopic right hemicolectomy with CME was completed. Exclusion criteria: (1) patients had severe organ dysfunction before operation; (2) tumor invaded adjacent organs or developed distant organ metastasis; (3) emergency surgery; (4) failure of laparoscopic surgery, and conversion to laparotomy; (5) without complete clinical data. Finally, clinical data of 141 patients in our hospital form March 2015 to February 2019 were retrospectively analyzed. CD grading standard was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyse were used to analyze the factors that might affect the complications. Survival analysis was conducted by grouping the indicators with statistically significant difference in multivariate analysis. Kaplan-Meier method was used to draw the survival curve and log-rank test was used to analyze the difference.
Results:Of the 141 patients, 89 were male and 52 were female with mean age of (61.8±11.0) years. All the operations completed successfully. A total of 37 postoperative complications were developed in 26 (18.4%) patients had postoperative 37 cases of complications, mainly including 7 delayed incision healing, 6 diarrhea, and 5 respiratory dysfunction. According to CD classification standard, grade I, II, and IV a complication rates were 40.5% (15/37), 56.8% (21/37), and 2.7% (1/37) respectively. Univariate analysis showed that age ≥ 65 years (χ2=4.338, P=0.037), BMI ≥ 28 kg/m2 (χ2=5.971, P=0.015), and preoperative hemoglobin < 100 g/L (χ2=3.985, P=0.046) were risk factors of postoperative complications. Multivariate analysis testified that age ≥ 65 years (OR=7.991, 95%CI: 2.203 to 28.983, P=0.002) and body mass index (BMI) ≥ 28 kg/m2 (OR=4.231, 95%CI: 1.034 to 17.322, P=0.045) were independent risk factors for complications after laparoscopic CME surgery for right-sided hemicolon cancer. All the patients were followed up for median time of 24 (1-48) months. The log-rank test showed that there were no significant differences in the cumulative survival rate between patients of age < 65 years and age ≥ 65 years (χ2=0.986, P=0.321), and between those with BMI < 28 kg/m2 and BMI ≥ 28 kg/m2 (χ2=0.370, P=0.543).
Conclusions:The main complications after CME in laparoscopic radical resection of right hemicolon cancer are CD grade I and II. Elderly and obesity are independent risk factor for postoperative complications. Before the operation, reasonable preventive measures should be taken for the elderly and the obese in order to reduce postoperative complications.
