Analysis of modified Clavien-Dindo classification and risk factors for postoperative early complications of radical proctectomy in rectal cancer / 国际外科学杂志

ABSTRACT

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 Grade12 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％ CI0.625-0.791,P =0.000) and 0.555 (95％ CI0.469-0.642,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.