Zhou Sicheng, Tang Jianqiang, Mei Shiwen, Lou Zheng, Fu Wei, Feng Bo, Yang Yingchi, Sun Yi, Liu Qian
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.
Jpn J Clin Oncol. 2022 Oct 6;52(10):1150-1158. doi: 10.1093/jjco/hyac109.
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.
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.
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.
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.
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。
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。
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。
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。
