Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Int J Colorectal Dis. 2019 Oct;34(10):1697-1703. doi: 10.1007/s00384-019-03374-3. Epub 2019 Aug 30.
The aim of this retrospective study was to evaluate the frequency and risk factors of urinary dysfunction after autonomic nerve-preserving surgery for rectal cancer.
This was a retrospective multiinstitution study of 1002 rectal cancer patients conducted between January 2008 and December 2012 in Yokohama Clinical Oncology Group. Patients who had preoperative urinary dysfunction or had not undergone autonomic nerve preservation surgery were excluded. Urinary dysfunction was defined as that with a Clavien-Dindo classification grade ≥ 2. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses.
A total of 887 patients were analyzed. Postoperative urinary dysfunction was observed in 77 patients (8.8%). A multivariate logistic analysis showed that a tumor location in lower rectum (odds ratio [OR] 2.16; 95% confidence interval [CI] 1.15-3.71; p = 0.02), tumor diameter ≥ 40 mm (OR 2.07; 95% CI 1.19-4.44; p < 0.01), operation time ≥ 240 min (OR 2.07; 95% CI 1.19-4.44; p < 0.01), blood loss ≥ 300 ml (OR 2.35; 95% CI 1.12-3.84; p = 0.02), and diabetes (OR 3.26; 95% CI 1.80-5.89; p < 0.01) were independent risk factors of urinary dysfunction. The incidence of urinary dysfunction exceeded 20% in patients with 3 preoperative predictors (tumor location, tumor diameter, diabetes).
This result demonstrated that high-risk patients with more than two risk factors should be informed of the risk of urinary dysfunction.
UMIN000033688.
本回顾性研究旨在评估直肠癌自主神经保护手术后尿功能障碍的频率和危险因素。
这是一项多机构回顾性研究，纳入了 2008 年 1 月至 2012 年 12 月期间在横滨临床肿瘤学组接受治疗的 1002 例直肠癌患者。排除术前存在尿功能障碍或未行自主神经保护手术的患者。尿功能障碍定义为 Clavien-Dindo 分级≥2 级。通过单因素和多因素分析检查患者、肿瘤和手术相关变量。
共分析了 887 例患者。77 例（8.8%）患者术后出现尿功能障碍。多因素 logistic 分析显示，肿瘤位于直肠下段（比值比 [OR] 2.16；95%置信区间 [CI] 1.15-3.71；p=0.02）、肿瘤直径≥40mm（OR 2.07；95% CI 1.19-4.44；p<0.01）、手术时间≥240min（OR 2.07；95% CI 1.19-4.44；p<0.01）、出血量≥300ml（OR 2.35；95% CI 1.12-3.84；p=0.02）和糖尿病（OR 3.26；95% CI 1.80-5.89；p<0.01）是尿功能障碍的独立危险因素。在术前有 3 个预测因素（肿瘤位置、肿瘤直径、糖尿病）的患者中，尿功能障碍的发生率超过 20%。
该结果表明，具有 2 个以上危险因素的高危患者应告知其发生尿功能障碍的风险。
UMIN000033688。
