ObjectiveTo compare the postoperative complications following laparoscopic and open radical resection for rectal cancer. MethodsThe clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups. Results①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05). ConclusionsThe development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.
Objective To classify the postoperative complications (POCs) in patients receiving esophagectomy and find risk factors of different grades of complications. Methods We retrospectively analyzed the clinical data of 298 patients with esophageal cancer who underwent esophagectomy from January 2012 to August 2015 in our hospital. According to the postoperative complications, they were divided into two groups: the complication group (n=113) and the non-complication group (n=185). In the complications group, there were 86 males and 27 females with an average age of 61.42±7.81 years. There were 150 males and 35 females with an average age of 60.39±7.76 years in the non-complication group. The POCs were classified by Clavien-Dindo system. All possible factors influencing the occurrence of grade Ⅱ-Ⅴ POCs were analyzed. Univariate and multivariate analyses were used for seeking independent risk factors of POCs. Results The incidence of grade Ⅱ POCs was 29.87% (89/298), 5.37% (16/298) for grade Ⅲ and 2.68% (8/298) for grade Ⅳ and Ⅴ. The most common POC was lung infection with the incidence of 13.76%. Univariate and multivariate analyses showed the operation duration and the number of lymph node dissection were the independent risk factors of grade Ⅱ-Ⅴ POCs. Conclusion Postoperative lung infection is the major complication in patients receiving esophagectomy. The operation duration and the number of lymph node dissection are the independent risk factors of grade Ⅱ-Ⅴ POCs.
Objective To analyze the safety of surgical treatment and optimal surgical procedure for lung cancer patients with prior history of lung resection. Methods The medical records of 69 lung cancer patients with history of lung resection was retrospectively collected. There were 53 males and 16 females with a median age of 68 years ranging from 45 to 80 years. The risk factors for postoperative complications were analyzed using one-way ANOVA and logistic regression analysis. By comparing the data between the lobectomy and sublobectomy groups, the best surgical procedure was chosen. Results The 90-day mortality rate was 4.3%. Postoperative complication rate was 24.6%. Results of one-way ANOVA showed that blood loss during operation (P=0.020), tumor size (P=0.007), smoking (P=0.028) and FEV1%pre (P=0.018) were associated with increased major postoperative complications. Logistic regression analysis showed that FEV1%pre<77.0% (OR=0.935, 95%CI 0.888 to 0.984, P=0.010) and tumor size≥2 cm (OR=4.288, 95%CI 1.375 to 13.373, P=0.012) were independent risk factors for major postoperative complications. Lobectomy and sublobectomy groups had similar postoperative mortality and complication rate (P=0.063). Conclusion Surgical resection for selected lung cancer patients with history of lung resection is safe with low postoperative mortality and complication rate. Lobectomy with lymph node resection is the first choice if cardiopulmonary function permits. Pneumonectomy is not recommended.
Objective To compare anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. Methods The clinical data of 147 patients underwent pancreaticoduodenectomy from January 2015 to June 2017 in the West China Hospital of Sichuan University were retrospectively analyzed. The modified triple-layer duct-to-mucosa pancreaticojejunostomy were used in 101 cases (MTL group) and end-to-end invagination pancreaticojejunostomy were used in 46 cases (IPJ group). The differences of intraoperative and postoperative statuses were compared between the two groups. Results The baseline data of these two groups had no significant differences (P>0.05). Except for the average time of the pancreaticoenterostomy of the MTL group was significantly longer than that of the IPJ group (P<0.05), the intraoperative blood loss, the first postoperative exhaust time, postoperative hospitalization time, reoperation rate, death rate, and rates of complications such as the pancreatic fistula, biliary fistula, anastomotic bleeding, gastric emptying disorder, and intraperitoneal infection had no significant differences between these two groups (P>0.05). Conclusions Both modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy are safe and effective. An individualized selection should be adopted according to specific situation of patient.
ObjectiveTo investigate factors associated with postoperative complications after laparoscopic radical surgery in rectal cancer.MethodsThe clinical data of patients with rectal cancer performed by the laparoscopic radical resection from February 2013 to December 2016 were analyzed retrospectively. All the data were analyzed by the t test, chi-square test or logistic regression analysis.ResultsThere were 343 patients with rectal cancer performed by the laparoscopic radical resection. The postoperative complications occurred in the 97 (28.3%) patients. The result of univariate analysis showed that the postoperative complications rate was associated with the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location and diameter of tumor, operative time, and surgeon experience (all P<0.050). The results of logistic regression analysis revealed that the gender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience were the independent risk factors for the postoperative complications (all P<0.050).ConclusionGender, age, body mass index, preoperative anemia, preoperative comorbidity, location of tumor, operative time, and surgeon experience are independent risk factors for postoperative complications in laparoscopic radical rectal surgery for rectal cancer.
ObjectiveTo compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically.MethodsA systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software.ResultsThirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77, P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI –79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to –209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01).ConclusionCompared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.
ObjectiveTo discuss the clinical characteristics and the management of major complications after thoracic surgery.MethodsRetrospective research was conducted on 15 213 patients who underwent thoracic surgery from January 2008 to September 2018 in our hospital. Thirty-six (0.24%) patients died of postoperative complications. Based on whether major complications such as severe pulmonary pneumonia and other 13 complications were presented postoperatively, the patients were divided into a complication group (n=389, 294 males and 95 females, aged 61.93±10.23 years) and a non-complication group (n=14 785, 8 636 males and 6 149 females, aged 55.27±13.21 years) after exclusion of unqualified patients. The age, gender distribution, diagnosis, surgical approach, postoperative hospital stay, in-hospital costs and other clinical data were analyzed. And the treatment and outcomes of the complications were summarized.ResultsThe age, proportion of male, malignancy and esophageal diseases, postoperative hospital stay and in-hospital costs in the complication group were significantly more or higher than those in the non-complication group (P<0.05). The top three causes of death among the 36 deaths were pulmonary embolism (PE, 25.00%), severe pulmonary pneumonia (16.67%) and acute respiratory failure (16.67%), respectively. The top five complications among the severe complication group were pulmonary pneumonia (24.73%), pleural space (19.83%), anastomotic leak (17.48%), pulmonary atelectasis (11.51%) and PE (6.18%).ConclusionThoracic surgeons should recognize patients with high risk of severe complications preoperatively based on clinical characteristics and perform multi-disciplinary treatment for severe complications.
ObjectiveTo provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.MethodsThe clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.ResultsThe incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1% vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate.ConclusionCOPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.
ObjectiveTo explore the treatment strategies for patients with fever and pulmonary complications after thoracic surgery during COVID-19 epidemic.MethodsThe clinical data of 537 patients who ungerwent selective surgery at the Department of Thoracic Surgery, Shangjin Branch of West China Hospital between February and December 2020 were retrospectively analyzed, including 242 (45.1%) males and 295 (54.9%) females aged 53.3±13.4 years. We have established a procedure for the patients with fever and pulmonary complications after thoracic surgery to investigate the cause of the disease and track risk factors.ResultsThe overall postoperative complication rate was 16.4% (88/537), and 1 (0.2%) patient died. Of 537 patients, 179 (33.3%) patients were enrolled in our model according to the inclusion criteria: ratio of males [112 (62.6%) vs. 130 (36.3%), P<0.010], patients with a history of smoking [74 (41.3%) vs. 87 (24.3%), P<0.010], or with esophageal cancer surgery [36 (20.1%) vs. 15 (4.2%)], or with traditional thoracotomy [14 (7.8%) vs. 4 (1.1%)] was higher than that of the other patients. Patients in our process due to fever or pulmonary complications had longer ICU stay and postoperative hospital stay (P=0.010). Logistic regression multivariate analysis showed that gender was an independent risk factor for postoperative fever or pulmonary complications.ConclusionIn low-risk areas of the epidemic, the treatment process is simple and feasible, and the cause traceability and corresponding treatment can basically be completed within 24 hours. At the same time, the treatment process has been running stably for a long time.
Objective To analyze the influence of the ABO blood types of colorectal cancer patients served by West China Hospital as a regional center on surgical characteristics and postoperative complications in the current version of Database from Colorectal Cancer (DACCA). Methods The DACCA version was updated on January 5, 2022. The data items included ABO blood type, sex, type of operation, nature of operation and postoperative complications. The operative characteristics and complications at different stages after operation (in hospital, short-term and long-term after operation) of colorectal cancer patients with different blood types (A, B, AB, O) were analyzed. Results According to the DACCA database, we obtained 5 010 analysable data rows, covering 2005–2022. The results of blood types analysis showed that there was no significant difference among different blood types in the overall postoperative complications and the occurrence of complications in hospital, short-term and long-term after operation (P>0.05). Further subgroup analysis showed that only the difference of anastomotic leakage among different blood types was statistically significant (χ2=9.588, P=0.022). There was no significant difference among different blood types in whether the primary focus of colon cancer surgery was removed or not, the degree of radical resection of the primary focus, and whether the anus was preserved or not in rectal cancer surgery (P>0.05), and there was significant difference among different blood types with different degrees of radical resection of primary rectal cancer (χ2=15.773, P=0.001). Conclusions The ABO blood types of patients with colorectal cancer has nothing to do with the occurrence of overall complications in the short and long term after operation, and has no impact on the implementation of different surgical methods. However, the occurrence of a single postoperative anastomotic leakage is related to blood type, and its possible causes need to be further explored.