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腹腔镜结直肠癌手术 30 天内再次手术的风险因素:一项日本多中心研究。

Risk factors for reoperation within 30 days in laparoscopic colorectal cancer surgery: A Japanese multicenter study.

机构信息

Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.

Department of Surgery, Isahaya General Hospital, Nagasaki, Japan.

出版信息

Asian J Endosc Surg. 2024 Jan;17(1):e13257. doi: 10.1111/ases.13257. Epub 2023 Nov 9.

Abstract

INTRODUCTION

Thirty-day reoperation rate reflects short-term surgical outcomes following surgery. Laparoscopic surgery for colorectal cancer reportedly has positive effects on postoperative complications. This retrospective study investigated risk factors for 30-day reoperation rate among patients after laparoscopic colorectal cancer surgery using a multicenter database.

METHODS

Participants comprised 3037 patients who had undergone laparoscopic resection of colorectal cancer between April 2016 and December 2022 at the Nagasaki University and six affiliated centers, classified into those who had undergone reoperation within 30 days after surgery (RO group; n = 88) and those who had not (NRO group; n = 2949). Clinicopathological characteristics were compared between groups.

RESULTS

In the RO group, anastomotic leakage occurred in 57 patients (64.8%), intestinal obstruction in 12 (13.6%), and intraabdominal abscess in 5 (5.7%). Female patients were more frequent, preoperative treatment less frequent, body mass index (BMI) lower, operation time longer, blood loss greater, and hospital stay longer in the RO group (p < .05 each). Multivariate analysis revealed BMI (odds ratio, 0.415; 95% confidence interval, 0.218-0.787; p = .021) and poor performance status (odds ratio, 1.966; 95% confidence interval, 1.106-3.492; p = .021) as independent predictors of reoperation.

CONCLUSION

Perioperative measures are warranted for patients with low BMI and poor performance status undergoing laparoscopic colorectal surgery.

摘要

简介

30 天再手术率反映了手术后的短期手术结果。据报道,腹腔镜结直肠癌手术对术后并发症有积极影响。本回顾性研究使用多中心数据库调查了腹腔镜结直肠癌手术后 30 天内再次手术率的患者的风险因素。

方法

参与者包括 2016 年 4 月至 2022 年 12 月在长崎大学和六家附属中心接受腹腔镜结直肠切除术的 3037 例患者,分为术后 30 天内接受再次手术的患者(RO 组,n=88)和未接受再次手术的患者(NRO 组,n=2949)。比较两组的临床病理特征。

结果

在 RO 组中,吻合口漏发生在 57 例(64.8%),肠梗阻 12 例(13.6%),腹腔脓肿 5 例(5.7%)。RO 组女性患者更常见,术前治疗较少,BMI 较低,手术时间较长,出血量较大,住院时间较长(p<0.05 各)。多因素分析显示 BMI(比值比,0.415;95%置信区间,0.218-0.787;p=0.021)和较差的表现状态(比值比,1.966;95%置信区间,1.106-3.492;p=0.021)是再次手术的独立预测因素。

结论

对于 BMI 低和表现状态差的接受腹腔镜结直肠手术的患者,需要进行围手术期措施。

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