Risk factors for complications after laparoscopic surgery in colorectal cancer patients: experience of 401 cases at a single institution.

摘要

BACKGROUND: Laparoscopic surgery is widely used for the treatment of colorectal cancer, but little is known about perioperative risk factors for complications. METHODS: Clinical data were reviewed for 401 consecutive unselected colorectal cancer patients who underwent laparoscopic surgery at Kyoto Medical Center between 1998 and 2005. The outcome variable was incidence of postoperative complications. Using logistic regression analysis, 58 background, clinical, preoperative, and intraoperative factors were assessed as potential predictors of complications. RESULTS: The set of independent protective factors that had the greatest influence on the incidence of local complications after colon surgery was as follows: cefmetazole use for prophylaxis (versus oral only; adjusted odds ratio (OR) 0.18, 95% confidence interval (CI) 0.06-0.54), high operative infusion rate (per ml/min; OR 0.82, 95% CI 0.70-0.95), regular laxative use (OR 0.33, 95% CI 0.12-0.79), and double-stapled anastomosis (versus hand-sewn; OR 0.15, 95% CI 0.03-0.83). Independent risk factors for local complications after rectal surgery were abdominoperineal resection (versus low anterior resection, OR 4.84, 95% CI 1.64-14.9), long operative time (per hour, OR 1.55, 95% CI 1.11-2.23), and history of heart disease (OR 5.18, 95% CI 1.34-21.5). The occurrence of complications was not found to be associated with overall survival in this study. CONCLUSIONS: We identified intraoperative management such as low operative infusion rate is one of the independent significant risk factors for complications after laparoscopic surgery for colorectal cancer in addition to patient characteristics and surgical procedure.