Department of Colorectal Surgery, Beaujon Hospital, Clichy, France.
Ann Surg. 2011 Nov;254(5):738-43; discussion 743-4. doi: 10.1097/SLA.0b013e31823604ac.
This study aimed to identify risk factors of postoperative 30-day mortality (POM) after colorectal cancer resection.
Meta-analyses have failed to demonstrate any significant benefit of laparoscopy in terms of postoperative mortality. This could be explained by the lack of a large sample size.
All patients who underwent colorectal resection for cancer between 2006 and 2008 in France were included. Data were extracted from the French National Health Service Database. A multivariate analysis evaluating risk factors for POM was performed including the following factors: age, gender, tumor location, associated comorbidities, emergency surgery, synchronous liver metastasis, malnutrition, and surgical approach.
During the 3-year period, a total of 84,524 colorectal resections for colorectal cancer were performed: 22,359 through laparoscopy (26%) and 62,165 through laparotomy (74%). From 2006 to 2008, laparoscopic approach rate increased from 23% to 29% (P < 0.001). POM was 5.0%: 2% after laparoscopy and 6% after laparotomy (P < 0.001). In multivariate analysis, 7 independent factors were significantly associated with a higher POM: age 70 years or more [P < 0.001, odds ratio (OR): 3.28; (3.00-3.59)], respiratory comorbidity [P < 0.001, OR: 3.16; (2.91-3.37)], vascular comorbidity [P < 0.001, OR: 2.66; (2.48-2.85)], neurologic comorbidity [P < 0.001, OR: 1.78; (1.51-2.09)], emergency surgery [P < 0.001, OR: 2.68; (2.48-2.90)], synchronous liver metastasis [P < 0.001, OR: 2.63; (2.41-2.86)], and preoperative malnutrition [OR: 1.33; (1.19-1.50)]. Laparoscopic surgery [P < 0.001, OR: 0.59; (0.54-0.65)] was independently associated with a significant decreased POM.
This all-inclusive national study showed that POM after colorectal cancer surgery is significantly reduced in case of age less than 70 years, elective surgery, and absence of synchronous liver metastasis, malnutrition, respiratory, neurologic, or vascular comorbidity. Furthermore, it is suggested that a laparoscopic surgery is independently associated with a decreased POM. This result, observed at a national level, must be considered when choosing the best surgical approach for colorectal cancer treatment.
本研究旨在确定结直肠癌手术后 30 天死亡率（POM）的风险因素。
荟萃分析未能证明腹腔镜在术后死亡率方面有任何显著优势。这可能是由于样本量不足所致。
纳入 2006 年至 2008 年间在法国接受结直肠癌切除术的所有患者。数据从法国国家卫生服务数据库中提取。进行了多变量分析，评估 POM 的风险因素，包括以下因素：年龄、性别、肿瘤位置、合并症、急诊手术、同步肝转移、营养不良和手术方法。
在 3 年期间，共进行了 84524 例结直肠癌切除术：22359 例采用腹腔镜（26%），62165 例采用剖腹手术（74%）。从 2006 年到 2008 年，腹腔镜手术率从 23%增加到 29%（P<0.001）。POM 为 5.0%：腹腔镜为 2%，剖腹手术为 6%（P<0.001）。多变量分析显示，7 个独立因素与更高的 POM 显著相关：年龄 70 岁或以上（P<0.001，优势比（OR）：3.28；（3.00-3.59））、呼吸系统合并症（P<0.001，OR：3.16；（2.91-3.37））、血管系统合并症（P<0.001，OR：2.66；（2.48-2.85））、神经系统合并症（P<0.001，OR：1.78；（1.51-2.09））、急诊手术（P<0.001，OR：2.68；（2.48-2.90））、同步肝转移（P<0.001，OR：2.63；（2.41-2.86））和术前营养不良（OR：1.33；（1.19-1.50））。腹腔镜手术（P<0.001，OR：0.59；（0.54-0.65））与 POM 显著降低独立相关。
这项全面的全国性研究表明，年龄小于 70 岁、择期手术和无同步肝转移、营养不良、呼吸系统、神经系统或血管系统合并症的结直肠癌手术后 POM 显著降低。此外，腹腔镜手术与 POM 降低独立相关。这一在全国范围内观察到的结果，在选择结直肠癌治疗的最佳手术方法时必须考虑。
