Stelzmueller Ingrid, Zitt Matthias, Aigner Felix, Kafka-Ritsch Reinhold, Jäger Robert, De Vries Alexander, Lukas Peter, Eisterer Wolfgang, Bonatti Hugo, Ofner Dietmar
Department of Visceral, Transplant, and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
J Gastrointest Surg. 2009 Apr;13(4):657-67. doi: 10.1007/s11605-008-0760-z. Epub 2008 Dec 11.
Postoperative morbidity remains a significant clinical problem and may alter long-term outcome particularly after neoadjuvant chemoradiation in patients with locally advanced low rectal cancer. The aim of the present study was to identify a potential long-term effect of postoperative morbidity.
Analysis of prospectively collected data of 90 consecutive patients who underwent neoadjuvant chemoradiation and curative mesorectal excision for locally advanced (cT3/4, Nx, M0/1) adenocarcinoma of the mid and lower third of the rectum during a 7-year period (1996-2002).
Major postoperative complications occurred in 17.8% and minor complications in 26.6% of patients. Hospital mortality and 30-day mortality was 0%. Infectious complications were seen in 34.5%. The leading causes of infectious complications were anastomotic leakage and perineal wound infection. Postoperative morbidity was statistically significantly associated with gender (P < 0.05), pre-therapeutic haemoglobin level (P < 0.05), ASA score (P < 0.05), hospitalisation (P < 0.001) and clinical long-time course (P < 0.01). Moreover, early postoperative morbidity was proven as an independent prognostic factor concerning disease-free (P < 0.05) and overall survival (P < 0.05).
Early postoperative morbidity in patients with preoperative chemoradiation due to locally advanced low rectal cancer is demonstrated as an independent prognosticator. Gender, pre-therapeutic haemoglobin level and ASA score indicate patients at risk for early postoperative complications and may therefore serve as predictive features.
术后发病率仍是一个重大的临床问题，可能会改变长期预后，尤其是在局部晚期低位直肠癌患者接受新辅助放化疗之后。本研究的目的是确定术后发病率的潜在长期影响。
分析在7年期间（1996 - 2002年）连续90例接受新辅助放化疗及根治性直肠系膜切除术的局部晚期（cT3/4，Nx，M0/1）直肠中下段腺癌患者的前瞻性收集数据。
17.8%的患者发生了主要术后并发症，26.6%的患者发生了次要并发症。医院死亡率和30天死亡率为0%。34.5%的患者出现感染性并发症。感染性并发症的主要原因是吻合口漏和会阴伤口感染。术后发病率与性别（P < 0.05）、治疗前血红蛋白水平（P < 0.05）、美国麻醉医师协会（ASA）评分（P < 0.05）、住院时间（P < 0.001）及临床长期病程（P < 0.01）在统计学上显著相关。此外，术后早期发病率被证明是无病生存（P < 0.05）和总生存（P < 0.05）的独立预后因素。
术前因局部晚期低位直肠癌接受放化疗患者的术后早期发病率被证明是一个独立的预后指标。性别、治疗前血红蛋白水平和ASA评分可提示术后早期并发症风险患者，因此可作为预测特征。
