Risk Factors for Severe Complications After Laparoscopic Surgery for T3 or T4 Rectal Cancer for Chinese Patients: Experience from a Single Center

Rectal Cancer Surgery in a District Hospital: Our Experience

Introduction Rectal cancer forms a significant proportion of newly diagnosed colorectal cancer. Treatment of rectal cancer is multi-modal, but surgery remains the cornerstone of treatment of rectal cancer and has undergone significant changes in the last three decades. The advent of minimally invasive techniques has revolutionised the landscape of surgery of the rectum. There is now a growing push to centralise rectal cancer surgery to tertiary centres only. We present the results of rectal cancer surgery from our district hospital. Methods This is a single-centre retrospective review of patients undergoing rectal cancer surgery from January 2018 to December 2019 at Northern Lincolnshire and Goole Trust. Results A total of 104 patients were included, with a mean age of 69.13 years (median 70, range 45-98 years). Of the patients, 65 (62.5%) patients were male and 39 (37.5%) patients were female. Neoadjuvant therapy was given to 34% of patients, while 66% of patients underwent surgery first. Anterior resection was performed in 64% of patients, abdomino-perineal resection was performed in 24% of patients, and Hartmann's type operations were performed in 9% of patients. Median length of stay was 9 days (range 2-78 days). Morbidity was 24%, and five patients had anastomotic leaks, of whom three had radiological drain insertion and two required re-operation. Mortality was 2.,8% and re-operations were performed in 2% of patients. Conclusion Rectal cancer surgery can be safely undertaken in district hospitals with adequately trained surgeons using a multi-disciplinary approach.

A retrospective study examining the association between polypharmacy and complications after laparoscopic surgery for colorectal cancer

BACKGROUND

Polypharmacy is an escalating public health concern across various healthcare settings worldwide. We aimed to comprehensively investigate postoperative complications after laparoscopic surgery for colorectal cancer and explore their association with polypharmacy. As laparoscopic surgery is widespread, clarifying the association between polypharmacy and postoperative complications is clinically important.

METHODS

We retrospectively surveyed the medical charts of adult inpatients who underwent laparoscopic surgery for colorectal cancer at Tohoku Medical and Pharmaceutical University Hospital between April 2019 and March 2023. Postoperative complications were determined using the Clavien-Dindo classification. We explored the factors related to postoperative complications and calculated the cut-off values for the number of medication ingredients.

RESULTS

Among the 236 patients, 32 (13.6%) developed postoperative complications. On multivariable logistic regression analysis, the number of regularly used medication ingredients (odds ratio = 1.160, 95% confidence interval 1.050-1.270, p = 0.002) was identified as a factor related to postoperative complications. The identified cut-off value for complications was 10 ingredients. Patients using 10 or more ingredients had approximately 3.5 times higher occurrence of postoperative complications than those using fewer than 10 ingredients (33.3% vs. 9.3%, p < 0.001, Fisher's exact test).

CONCLUSIONS

Our study comprehensively investigated postoperative complications and examined their association with polypharmacy. We found that the number of regularly used medication ingredients may be linked to complications following laparoscopic surgery for colorectal cancer. These findings have important implications for perioperative management and patient care, providing valuable insights that may influence clinical practices and enhance patient outcomes.

Development and validation of a nomogram to predict the risk factors of major complications after radical rectal cancer surgery

Purpose

The aim of this study was to establish a validated nomogram to predict risk factors for major post-operative complications in patients with rectal cancer (RC) by analyzing the factors contributing to major post-operative complications in RC patients.

Methods

We retrospectively collected baseline and surgical information on patients who underwent RC surgery between December 2012 and December 2022 at a single-center teaching hospital. The entire cohort was randomly divided into two subsets (60% of the data for development, 40% for validation). Independent risk factors for major post-operative complications were identified using multivariate logistic regression analyses, and predictive models were developed. Area under the curve (AUC) was calculated using receiver operating characteristic curve (ROC) to assess predictive probability, calibration curves were plotted to compare the predicted probability of the nomogram with the actual probability, and the clinical efficacy of the nomogram was assessed using decision curve analysis (DCA).

Results

Our study included 3151 patients who underwent radical surgery for RC, including 1892 in the development set and 1259 in the validation set. Forty (2.1%) patients in the development set and 26 (2.1%) patients in the validation set experienced major post-operative complications. Through multivariate logistic regression analysis, age (p<0.01, OR=1.044, 95% CI=1.016-1.074), pre-operative albumin (p<0.01, OR=0.913, 95% CI=0.866-0.964), and open surgery (p<0.01, OR=2.461, 95% CI=1.284-4.761) were identified as independent risk factors for major post-operative complications in RC, and a nomogram prediction model was established. The AUC of the ROC plot for the development set was 0.7161 (95% Cl=0.6397-0.7924), and the AUC of the ROC plot for the validation set was 0.7191 (95% CI=0.6182-0.8199). The predicted probabilities in the calibration curves were highly consistent with the actual probabilities, which indicated that the prediction model had good predictive ability. The DCA also confirmed the good clinical performance of the nomogram.

Conclusion

In this study, a validated nomogram containing three predictors was created to identify risk factors for major complications after radical RC surgery. Due to its accuracy and convenience, it could contribute to personalized management of patients in the perioperative period.