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@#Objective To investigate the risk factors for postoperative complications Clavien-Dindo classification≥grade Ⅱ after lung cancer surgery. Methods The patients who underwent lung cancer surgery in a multicenter observational study from November 2017 to January 2020 were included. The Clavien-Dindo classification of postoperative complications was analyzed. Logistic regression was used to identify the risk factors for complications≥ gradeⅡ. Results A total of 388 patients were enrolled, including 203 males and 185 females with a mean age of 56.14±10.36 years. The incidence of postoperative complications was 25.52% (99/388) after lung cancer surgery and the incidence of complications≥gradeⅡ was 20.10% (78/388). The five most common postoperative complications were pneumonia (6.96%), prolonged pulmonary air leak (>7 days, 5.67%), incision dehiscence (4.64%), arrhythmia (3.87%), and postoperative pleural effusion (3.35%). Multivariate analysis showed that open surgery [reference: uniportal thoracoscopic surgery, OR=2.18, 95%CI (1.01, 4.70), P=0.047], extended resection [reference: sublobar resection, OR=2.86, 95%CI (1.11, 7.19), P=0.030; reference: lobectomy, OR=2.20, 95%CI (1.10, 4.40), P=0.026] and operative time≥3 h [OR=2.07, 95%CI (1.12, 3.85), P=0.021] were independent risk factors for postoperative complications≥gradeⅡ after lung cancer surgery. Conclusion Surgical approach, extent of resection and operative time are independent influencing factors for postoperative complications≥gradeⅡ after lung cancer surgery.
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Objective@#To investigate the Clavien-Dindo (CD) classification of complications after complete mesocolic excision (CME) in laparoscopic radical resection of right-sided hemicolon cancer and its influencing factors.@*Methods@#A retrospective case-control study was performed. Inclusion criteria: (1) the adenocarcinoma located at colon from cecum to hepatic flexure; (2) laparoscopic right hemicolectomy with CME was completed. Exclusion criteria: (1) patients had severe organ dysfunction before operation; (2) tumor invaded adjacent organs or developed distant organ metastasis; (3) emergency surgery; (4) failure of laparoscopic surgery, and conversion to laparotomy; (5) without complete clinical data. Finally, clinical data of 141 patients in our hospital form March 2015 to February 2019 were retrospectively analyzed. CD grading standard was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyse were used to analyze the factors that might affect the complications. Survival analysis was conducted by grouping the indicators with statistically significant difference in multivariate analysis. Kaplan-Meier method was used to draw the survival curve and log-rank test was used to analyze the difference.@*Results@#Of the 141 patients, 89 were male and 52 were female with mean age of (61.8±11.0) years. All the operations completed successfully. A total of 37 postoperative complications were developed in 26 (18.4%) patients had postoperative 37 cases of complications, mainly including 7 delayed incision healing, 6 diarrhea, and 5 respiratory dysfunction. According to CD classification standard, grade I, II, and IV a complication rates were 40.5% (15/37), 56.8% (21/37), and 2.7% (1/37) respectively. Univariate analysis showed that age ≥ 65 years (χ2=4.338, P=0.037), BMI ≥ 28 kg/m2 (χ2=5.971, P=0.015), and preoperative hemoglobin < 100 g/L (χ2=3.985, P=0.046) were risk factors of postoperative complications. Multivariate analysis testified that age ≥ 65 years (OR=7.991, 95%CI: 2.203 to 28.983, P=0.002) and body mass index (BMI) ≥ 28 kg/m2 (OR=4.231, 95%CI: 1.034 to 17.322, P=0.045) were independent risk factors for complications after laparoscopic CME surgery for right-sided hemicolon cancer. All the patients were followed up for median time of 24 (1-48) months. The log-rank test showed that there were no significant differences in the cumulative survival rate between patients of age < 65 years and age ≥ 65 years (χ2=0.986, P=0.321), and between those with BMI < 28 kg/m2 and BMI ≥ 28 kg/m2 (χ2=0.370, P=0.543).@*Conclusions@#The main complications after CME in laparoscopic radical resection of right hemicolon cancer are CD grade I and II. Elderly and obesity are independent risk factor for postoperative complications. Before the operation, reasonable preventive measures should be taken for the elderly and the obese in order to reduce postoperative complications.
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Objective To investigate the modified Clavien-Dindo classification and risk factors for postoperative early complications of radical proctectomy in rectal cancer.Methods The clinical data of 187 patients,including 99 male cases and 88 female cases with the average age (64.5 ± 10.8) years old (ranged from 37 to 87 years),with radical resection of rectal cancer were analyzed retrospectively in Anqing Hospital Affiliated of Anhui Medical University between August 2014 and October 2018,and the occurrence of early postoperative complications was analyzed according to the modified Clavien-Dindo grade system.The relationship between 32 variables and complications in the data was analyzed by single factor and multiple factors in order to explore the risk factors of early postoperative complications.Results One hundred and eighty seven patients with radical proctectomy,54 cases (28.9％,54/187) had early postoperative complications,including 15 cases of serious complications (8.0％,15/187),3 cases were performed second surgeries under general anesthesia (1.6％,3/187).Postoperative modified Clavien-Dindo Grade:12 cases with grade Ⅰ,27 cases with grade Ⅱ,11 cases with grade Ⅲ a,3 cases with grade Ⅲ b,1 case with grade Ⅳ a,no case with grade Ⅳ b and Ⅴ.The results of single factor analysis showed age (x2 =4.788,P =0.029),ASA grade (x2 =26.903,P =0.000),multiple organ resection (x2 =4.749,P =0.029),pT stage (x2 =8.080,P =0.044),pTNM stage (x2 =6.29,P =0.043),total harvested lymph node number (x2 =5.542,P =0.019).The occurrence of early complications after radical proctectomy,multi-factor analysis found that ASA grade (OR =3.539,P =0.000),pTNM stage (OR =1.846,P =0.034) was an independent risk factor for early postoperative complications of rectal cancer.The area (AUC value) under the curve of the prediction of early postoperative complications in patients with ASA grade and pTNM stage was 0.708 (95％ CI:0.625-0.791,P =0.000) and 0.555 (95％ CI:0.469-0.642,P =0.235).Conclusions Early complications after radical resection of rectal cancer are closely related to ASA grade and tumor pTNM staging.ASA grade can be used as a significant predictor of early complications after radical proctectomy in rectal cancer.
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OBJECTIVE: To analyze the relationship between clinical characteristics and postoperative complications in patients with hilar cholangiocarcinoma(HCCA) who underwent major liver resection(MLR).METHODS: Clinical characteristics and postoperative complications of 335 patients with HCCA who underwent MLR from January 2010 to October 2017 were retrospectively analyzed.According to the severity of complications,the patients were divided into two groups:low clavien-dindo group(LCD)and high clavien-dindo group(HCD).RESULTS: There were 219 patients in LCD group and 116 patients in HCD group.Elevated INR,Bismuth Ⅲa/Ⅳ type and the right liver/expanding right/right trilobites resection were high risk factors of postoperative serious complications.The incidence of severe postoperative complications in the group with preoperative biliary drainage was 34.18%(67/196),which was not statistically significant different from that in the group without preoperative biliary drainage [35.25%(49/139),P=0.8396].The dose-response curve and Logistic regression indicated that there was a statistical difference in postoperative complication risk between patients with total bilirubin(TB)<140 mol/L and patients with TB≥ 140 mol/L(OR=1.917,95% CI 1.147～3.203,P=0.0130).After statistical correction,the statistical correlation remained,among which,the preoperative biliary drainage rate was 59.2%(151/255) in the group with TB<140 mol/L,and 56.3%(45/80)in the group with TB≥ 140 mol/L.CONCLUSION: In patients with HCCA combined with MLR,patients with TB ≥ 140 mol/L should be routinely treated with preoperative biliary drainage.Especially for the right liver resection,preoperative high INR patients,more attention should be paid to.METHODS: of preoperative biliary drainage have no significant effect on the overall postoperative complications and can be flexibly selected according to the needs of the disease.
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Gastric cancer is a common gastrointestinal cancer.With the incidence of cancer in the middle and proximal stomach is increasing year by year,radical total gastrectomy as a major operative method,is widely used in the treatment of gastric cancer.However,various surgical complications often occur after total gastrectomy,which affect patients' postoperative recovery and the quality of life.This article discussed the influential factors of surgical complications after total gastrectomy,and discussed the feasibility of applying Clavien-Dindo classification system to evaluate the severity of complications after total gastrectomy.
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Objective@#To semi-quantify the postoperative complications occurred after laparoscopic pancreaticoduodenectomy(LPD) using Clavien-Dindo score, thereafter exploring its impact factors.@*Methods@#In this retrospective cohort study, the clinical data of 124 patients who had undergone LPD for periampullary tumor from June 2016 to June 2017 at Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology were collected.Malignancy was confirmed based on postoperative pathological reports.Postoperative complications were semi-quantitated using Clavien-Dindo score.Multivariable logistic regression model was applied to explore the factors related to severe complications(Clavien-Dindo Ⅲb-Ⅴ).@*Results@#Of the 124 patients, there were 64 males(51.6%) and 60 females(48.4%), with age of 57 years(range, 23-82 years). In total, postoperative complications occurred in 30 patients(24.2%). Among the 30 patients, 4 patients suffered Clavien-Dindo grade Ⅰ, 18 patients(14.5%) suffered Clavien-Dindo grade Ⅱ, 6 patients(4.8%) suffered Clavien-Dindo grade Ⅲa, 1 patient(0.1%) suffered Clavien-Dindo grade Ⅳb, and 1 patient(0.1%) suffered Clavien-Dindo grade Ⅴ.Intraabdominal hemorrhage occurred in 8 patients, pancreatic fistula was found in 10 patients(7 patients had biochemical leakage and 3 of them had grade B pancreatic fistula), both biliary fistula and gastrointestinal fistula were found in 1 patient.Abdominal infection occurred in 10 patients, both liver failure and renal failure occurred in one patient.Moreover, arrhythmia was found in two patients, and mortality occurred in one patient.Five patients suffered multiple complications.Univariable analysis showed that postoperative complications were associated with body mass index, American Society of Anesthesiologists(ASA) score, intraoperative blood transfusion, and pancreatic texture(P<0.05). In multivariable logistic regression, ASA grade Ⅲ, intraoperative blood transfusion, and pancreatic softness were independently related to postoperative complications after LPD(P<0.05).@*Conclusions@#Clavien-Dindo score is feasible to be applied in management of patients with LPD.ASA score, texture of pancreas, and intraoperative blood transfusion were independently associated with postoperative complications.
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Objective Compare the complications between laparoscopic and abdominal cervical cancer surgery, and investigate the safety of laparoscopic cervical cancer surgery and complications classified by Clavien-Dindo classification, then analyze the risk factors. Method Clinical data of 215 cases of cervical cancer received surgery from March 2011 to October 2014 was collected, which include intraoperative, postoperative and postoperative fol﹣low-up data. All the cases were divided into two groups: LRH group (n= 116) and ARH group (n= 88), then ana﹣lyze and compare the difference of intraoperative, postoperative complications and postoperative follow-up data be﹣tween the two groups, assess the safety of the two groups, and statistically concluded related independent risk factors. Results The complications of 204 patients were classified into 4 grades. The criticality and morbidity of intraopera﹣tive and postoperative complications have no significant difference between the two groups (P> 0.05). Logistic re﹣gression analysis show that over criticality grade Ⅱ of LRH intraoperative complication related to operating time, over criticality grade Ⅱ of ARH intraoperative complication related to aged over 50 yr, over criticality grade Ⅱ of ARH intraoperative complication related to BMI> 25. Conclusions Through the analysis of laparoscopic operation and the criticality of complications, the safety of the two groups were no difference. The patients with high risk fac﹣tors should be evaluated comprehensively. And strictly grasp the contraindication and indication.
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Objective To analyze the Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and investigate the relationship between the major risk factors and Clavien-Dindo classification of complications.Methods The retrospective case-control study was adopted.The clinical data of 200 patients who underwent pancreaticoduodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected.The patients underwent Whipple surgery or pylorospreserving pancreaticoduodenectomy according to the tumor location.Observation indicators included:(1)postoperative complications using Clavien-Dindo classification,(2) univariate and multivariate analyses:the basic conditions of patients,surgery-related factors,pancreas-related factors,(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy.The univariate analysis and count data were done using the chi-square test.The comparison between groups was done using independent samples nonparametric test (Kolmogorov-Smirnov Z) and multivariate analysis was done using the Logistic regression model.Results (1) Postoperative complication situations:of 200 patients,122 underwent Whipple surgery and 78 underwent pylorus-preserving pancreatico-duodenectomy,including 6 combined with vascular reconstruction and 1 with radiofrequency ablation of liver tumors.Ninety-eight patients had postoperative complications,including 41 patients with 2 or above kinds of complications.Pancreatic fistula was detected in 80patients,including 42 with grade A,28 with grade B and 10 with grade C,wound infection in 29 patients,delayed gastric emptying in 24 patients,postoperative intra-abdominal infection in 16 patients,postoperative intraabdominal hemorrhage in 10 patients including 8 receiving interventional treatment,postoperative biliary leakage in 7 patients and unintended reoperation in 2 patients.Three patients were dead during hospitalization.The incidence of complications in grade Ⅰ,Ⅱ,Ⅲ (Ⅲ a and Ⅲ b),Ⅳ and V of Clavien-Dindo classification was 28.00％(56/200),13.00％ (26/200),5.00％ (10/200),1.50％ (3/200) and 1.50％ (3/200).(2) The univariate and multivariate analyses:the results of univariate analysis showed that body mass index (BMI) and texture of the pancreas were risk factors affecting complications after pancreatico-duodenectomy (x2=6.483,Z =-3.189,P ＜0.05).The results of multivariate analysis showed that BMI ＞ 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR =2.044,1.649,95 ％ confidence interval:1.212-3.447,1.194-2.275).(3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed,there were statistically significant differences between BMI or texture of the pancreas and Clavien-Dindo classification of complications after pancreaticoduodenectomy (x2 =13.897,27.077,P ＜ 0.05).Conclusions Clavien-Dindo classification of complications after pancreaticoduodenectomy is in favor of comprehensive comparisons and quality assessments among different studies,the primary classification is grade Ⅰ and Ⅱ.And decreasing BMI and good management of pancreatic stump may affect Clavien-Dindo classification of complications after pancreaticoduodenectomy.