直肠癌侧方盆腔淋巴结清扫术后并发症的危险因素及预后意义：中国多中心侧方淋巴结研究结果
Risk factors and prognostic significance of postoperative complications following lateral pelvic lymph node dissection for rectal cancer: results of the multicenter lateral node study in China.
作者信息
Zhou Sicheng, Tang Jianqiang, Mei Shiwen, Lou Zheng, Fu Wei, Feng Bo, Yang Yingchi, Sun Yi, Liu Qian
机构信息
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China.
出版信息
Jpn J Clin Oncol. 2022 Oct 6;52(10):1150-1158. doi: 10.1093/jjco/hyac109.
OBJECTIVE
Total mesorectal excision (TME) plus lateral pelvic lymph node (LPN) dissection (LPND) is a technically complex and challenging procedure with higher morbidity than TME alone. We aimed to investigate the risk factors for postoperative complications after TME + LPND, and the impact of complications on patient prognosis.
METHODS
A total of 387 rectal cancer patients with clinical LPN metastasis (LPNM) who underwent TME + LPND at three institutions affiliated with the Chinese Lateral Node Collaborative Group were included. Logistic regression models were used to identify the risk factors for post-surgical complications, and the log-rank test was used to compare the prognosis. Severe complications were described as grade III-V.
RESULTS
The incidence rates of overall complications and severe complications after TME + LPND were 15.2% (59/387) and 7.8% (30/387), respectively. Multivariate analysis showed that a duration of operation ≥260 min was an independent risk factor for both overall (odds ratio [OR] = 3.03, 95% confidence interval [CI] = 1.57-5.85, P = 0.001) and severe postoperative complications (OR = 2.67, 95% CI = 1.06-6.73, P = 0.037). The development of overall postoperative complications (P = 0.114) and severe postoperative complications (P = 0.298) had no significant impact on the overall survival. However, patients with overall complications (P = 0.015) or severe complications (P = 0.031) with a postoperative hospital stay >30 days had significantly an overall worse survival.
CONCLUSION
A surgical duration of ≥260 min is a significant risk factor for both overall and severe postoperative complications after TME + LPND for middle-low rectal cancer. Furthermore, the development of overall complications or severe complications that require a postoperative hospital stay >30 days significantly worsens the prognosis.
目的
全直肠系膜切除术（TME）加侧方盆腔淋巴结（LPN）清扫术（LPND）是一项技术复杂且具有挑战性的手术，其发病率高于单纯TME。我们旨在研究TME + LPND术后并发症的危险因素，以及并发症对患者预后的影响。
方法
纳入中国侧方淋巴结协作组下属三家机构中387例临床诊断为LPN转移（LPNM）的直肠癌患者，这些患者均接受了TME + LPND。采用Logistic回归模型确定术后并发症的危险因素，采用对数秩检验比较预后。严重并发症定义为III - V级。
结果
TME + LPND术后总体并发症和严重并发症的发生率分别为15.2%（59/387）和7.8%（30/387）。多因素分析显示，手术时间≥260分钟是总体（比值比[OR]=3.03，95%置信区间[CI]=1.57 - 5.85，P = 0.001）和严重术后并发症（OR = 2.67，95% CI = 1.06 - 6.73，P = 0.037）的独立危险因素。总体术后并发症（P = 0.114）和严重术后并发症（P = 0.298）的发生对总生存率无显著影响。然而，术后住院时间>30天的总体并发症（P = 0.015）或严重并发症（P = 0.031）患者的总生存率明显更差。
结论
对于中低位直肠癌，手术时间≥260分钟是TME + LPND术后总体和严重并发症的重要危险因素。此外，需要术后住院时间>30天的总体并发症或严重并发症的发生会显著恶化预后。
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