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Zhang SQ, Wu ZQ, Huo BW, Xu HN, Zhao K, Jing CQ, Liu FL, Yu J, Li ZR, Zhang J, Zang L, Hao HK, Zheng CH, Li Y, Fan L, Huang H, Liang P, Wu B, Zhu JM, Niu ZJ, Zhu LH, Song W, You J, Yan S, Li ZY. [Incidence of postoperative complications in Chinese patients with gastric or colorectal cancer based on a national, multicenter, prospective, cohort study]. Zhonghua Wei Chang Wai Ke Za Zhi 2024; 27:247-260. [PMID: 38532587 DOI: 10.3760/cma.j.cn441530-20240218-00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Objective: To investigate the incidence of postoperative complications in Chinese patients with gastric or colorectal cancer, and to evaluate the risk factors for postoperative complications. Methods: This was a national, multicenter, prospective, registry-based, cohort study of data obtained from the database of the Prevalence of Abdominal Complications After Gastro- enterological Surgery (PACAGE) study sponsored by the China Gastrointestinal Cancer Surgical Union. The PACAGE database prospectively collected general demographic characteristics, protocols for perioperative treatment, and variables associated with postoperative complications in patients treated for gastric or colorectal cancer in 20 medical centers from December 2018 to December 2020. The patients were grouped according to the presence or absence of postoperative complications. Postoperative complications were categorized and graded in accordance with the expert consensus on postoperative complications in gastrointestinal oncology surgery and Clavien-Dindo grading criteria. The incidence of postoperative complications of different grades are presented as bar charts. Independent risk factors for occurrence of postoperative complications were identified by multifactorial unconditional logistic regression. Results: The study cohort comprised 3926 patients with gastric or colorectal cancer, 657 (16.7%) of whom had a total of 876 postoperative complications. Serious complications (Grade III and above) occurred in 4.0% of patients (156/3926). The rate of Grade V complications was 0.2% (7/3926). The cohort included 2271 patients with gastric cancer with a postoperative complication rate of 18.1% (412/2271) and serious complication rate of 4.7% (106/2271); and 1655 with colorectal cancer, with a postoperative complication rate of 14.8% (245/1655) and serious complication rate of 3.0% (50/1655). The incidences of anastomotic leakage in patients with gastric and colorectal cancer were 3.3% (74/2271) and 3.4% (56/1655), respectively. Abdominal infection was the most frequently occurring complication, accounting for 28.7% (164/572) and 39.5% (120/304) of postoperative complications in patients with gastric and colorectal cancer, respectively. The most frequently occurring grade of postoperative complication was Grade II, accounting for 65.4% (374/572) and 56.6% (172/304) of complications in patients with gastric and colorectal cancers, respectively. Multifactorial analysis identified (1) the following independent risk factors for postoperative complications in patients in the gastric cancer group: preoperative comorbidities (OR=2.54, 95%CI: 1.51-4.28, P<0.001), neoadjuvant therapy (OR=1.42, 95%CI:1.06-1.89, P=0.020), high American Society of Anesthesiologists (ASA) scores (ASA score 2 points:OR=1.60, 95% CI: 1.23-2.07, P<0.001, ASA score ≥3 points:OR=0.43, 95% CI: 0.25-0.73, P=0.002), operative time >180 minutes (OR=1.81, 95% CI: 1.42-2.31, P<0.001), intraoperative bleeding >50 mL (OR=1.29,95%CI: 1.01-1.63, P=0.038), and distal gastrectomy compared with total gastrectomy (OR=0.65,95%CI: 0.51-0.83, P<0.001); and (2) the following independent risk factors for postoperative complications in patients in the colorectal cancer group: female (OR=0.60, 95%CI: 0.44-0.80, P<0.001), preoperative comorbidities (OR=2.73, 95%CI: 1.25-5.99, P=0.030), neoadjuvant therapy (OR=1.83, 95%CI:1.23-2.72, P=0.008), laparoscopic surgery (OR=0.47, 95%CI: 0.30-0.72, P=0.022), and abdominoperineal resection compared with low anterior resection (OR=2.74, 95%CI: 1.71-4.41, P<0.001). Conclusion: Postoperative complications associated with various types of infection were the most frequent complications in patients with gastric or colorectal cancer. Although the risk factors for postoperative complications differed between patients with gastric cancer and those with colorectal cancer, the presence of preoperative comorbidities, administration of neoadjuvant therapy, and extent of surgical resection, were the commonest factors associated with postoperative complications in patients of both categories.
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Affiliation(s)
- S Q Zhang
- Department of Public Health, Qinghai University School of Medicine, Xining 810001, China
| | - Z Q Wu
- Gastrointestinal Cancer Center, Beijing Cancer Hospital, Beijing 100142, China
| | - B W Huo
- Department of Gastrointestinal (Oncology) Surgery, Affiliated Hospital of Qinghai University, Xining 810001, China
| | - H N Xu
- Department of Gastrointestinal (Oncology) Surgery, Affiliated Hospital of Qinghai University, Xining 810001, China
| | - K Zhao
- Department of Gastrointestinal (Oncology) Surgery, Affiliated Hospital of Qinghai University, Xining 810001, China
| | - C Q Jing
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan 250021, China
| | - F L Liu
- Department of Gastric Surgery, Cancer Hospital, Fudan University, Shanghai 200025, China
| | - J Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Z R Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - J Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, China
| | - L Zang
- Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China
| | - H K Hao
- Department of Gastrointestinal Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - C H Zheng
- Department of Gastroenterology, Union Hospital of Fujian Medical University, Fuzhou 350001, China
| | - Y Li
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - L Fan
- Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - H Huang
- Department of Gastric Surgery, Cancer Hospital, Fudan University, Shanghai 200025, China
| | - P Liang
- Department of Gastrointestinal Surgery, the First Hospital of Dalian Medical University, Dalian 116011, China
| | - B Wu
- Department of Basic Surgery, Union Hospital of Peking Union Medical College, Beijing 100032, China
| | - J M Zhu
- Department of Gastrointestinal Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110002, China
| | - Z J Niu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - L H Zhu
- Department of Gastrointestinal Surgery, Run Run Shaw Hospital, Zhejiang University, Hangzhou 310009, China
| | - W Song
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510062, China
| | - J You
- Department of Gastrointestinal Oncology, the First Affiliated Hospital of Xiamen University, Xiamen 361003, China;Zhang Shuqin is now working at Department of Infection Management, Suqian Hospital, Xuzhou Medical University
| | - S Yan
- Department of Gastrointestinal (Oncology) Surgery, Affiliated Hospital of Qinghai University, Xining 810001, China
| | - Z Y Li
- Gastrointestinal Cancer Center, Beijing Cancer Hospital, Beijing 100142, China
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Yang L, Wu JZ, You J, Fan L, Jing CQ, Wang Q, Yan S, Yu J, Zang L, Xing JD, Hu WQ, Liu F. [A multicenter retrospective study on the efficacy of different anti-reflux reconstruction methods after proximal gastrectomy for gastric cancer]. Zhonghua Wai Ke Za Zhi 2022; 60:838-845. [PMID: 36058710 DOI: 10.3760/cma.j.cn112139-20220418-00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To examine the clinical efficacy of 3 anti-reflux methods of digestive tract reconstruction after proximal gastrectomy for gastric cancer. Methods: The clinical data and follow-up data of gastric cancer patients who underwent anti-reflux reconstruction after proximal gastrectomy in 11 medical centers of China from September 2016 to August 2021 were retrospectively collected, including 273 males and 65 females, aging of (63±10) years (range: 28 to 91 years). Among them, 159 cases were performed with gastric tube anastomosis (GTA), 107 cases with double tract reconstruction (DTR), and 72 cases with double-flap technique (DFT), respectively. The duration of operation, length of postoperative hospital stay and early postoperative complications (referring to Clavien-Dindo classification) of different anti-reflux reconstruction methods were assessed. Body mass index, hemoglobin and albumin were used to reflect postoperative nutritional status. Reflux esophagitis was graded according to Los Angeles criteria based on the routinely gastroscopy within 12 months after surgery. The postoperative quality of life (QoL) was evaluated by Visick score system. The ANOVA analysis, Kruskal-Wallis rank sum test, χ2 test and Fisher's exact test were used for comparison between multiple groups, and further comparison among groups were performed with LSD, Tamhane's test or Bonferroni corrected χ2 test. The mixed effect model was used to compare the trends of Body mass index, hemoglobin and albumin over time among different groups. Results: The operation time of DFT was significantly longer than that of GTA and DTR ((352±63) minutes vs. (221±66) minutes, (352±63) minutes vs. (234±61) minutes, both P<0.01). The incidence of early complications with Clavien-Dindo grade Ⅱ to Ⅴ in GTA, DFT and DTR groups was 17.0% (27/159), 9.7% (7/72) and 10.3% (11/107), respectively, without significant difference among these three groups (χ2=3.51, P=0.173). Body mass index decreased more significantly in GTA than DFT group at 6 and 12 months after surgery (mean difference=1.721 kg/m2, P<0.01; mean difference=2.429 kg/m2, P<0.01). body mass index decreased significantly in DTR compared with DFT at 12 months after surgery (mean difference=1.319 kg/m2, P=0.027). There was no significant difference in hemoglobin or albumin fluctuation between different reconstruction methods perioperative. The incidence of reflux esophagitis one year after surgery in DTR group was 12.9% (4/31), which was lower than that in DFT (45.9% (17/37), χ2=8.63, P=0.003). Follow-up of postoperative quality of life showed the incidence of Visick grade 2 to 4 in DFT group was lower than that in GTA group (10.4% (7/67) vs. 34.6% (27/78), χ2=11.70, P=0.018), while there was no significant difference between DFT and DTR group (10.4% (7/67) vs. 22.2% (8/36, P>0.05). Conclusions: Compared with GTA and DTR, DFT is more time-consuming, but there is no significant difference in early complications among three methods. DFT reconstruction is more conducive to maintain postoperative nutritional status and improve QoL, especially compared with GTA. The risk of reflux esophagitis after DTR reconstruction is lower than that of DFT.
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Affiliation(s)
- L Yang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - J Z Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - J You
- Department of Gastrointestinal Oncology Surgery, the First Affiliated Hospital, Xiamen University, Xiamen 361000, China
| | - L Fan
- Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - C Q Jing
- Department of General Surgery, Shandong Provincial Hospital, Jinan 250021, China
| | - Q Wang
- Department of General Surgery, the First Affiliated Hospital of Jilin University, Changchun 130061, China
| | - S Yan
- Department of Gastrointestinal Oncology Surgery, the Affiliated Hospital of Qinghai University, Xining 810001, China
| | - J Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - L Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - J D Xing
- Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100143, China
| | - W Q Hu
- Department of General Surgery, Changzhi People's Hospital, Changzhi 046099, China
| | - Fenglin Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Abstract
The aim of this study was to clone the isoflavone synthase (IFS) gene and establish the recombinant Minshan Trifolium pratense. The IFS gene was cloned from the callus of Minshan T. pratense using reverse transcription-polymerase chain reaction. The plant expression vector pRI101-AN-IFS was constructed and introduced into Agrobacterium tumefaciens strain LBA4404, and then screened under cephalosporin. IFS expression was detected by reverse transcription-polymerase chain reaction. The IFS gene was cloned successfully. Sequence analysis indicated that IFS gene had high homology with similar genes from other plants. The IFS-overexpressing callus was obtained by introducing the LBA4404-harboring IFS-pRI101-AN-IFS vector into T. pratense calluses.
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Affiliation(s)
- H H Hu
- College of Life Science and Technology, Sanquan School, Xinxiang Medical University, Xinxiang, China
| | - C Q Jing
- College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
| | - R Liu
- College of Life Science and Technology, Sanquan School, Xinxiang Medical University, Xinxiang, China
| | - W D Li
- College of Life Science and Technology, Sanquan School, Xinxiang Medical University, Xinxiang, China
| | - H G Feng
- College of Life Science and Technology, Xinxiang Medical University, Xinxiang, China
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