The risk of postoperative complications is higher in stage I-III colorectal cancer patients with previous abdominal surgery: a propensity score matching analysis

PURPOSE

The aim of this study is to investigate whether previous abdominal surgery (PAS) affected stage I-III colorectal cancer (CRC) patients who underwent radical resection.

METHODS

Stage I-III CRC patients who received surgery at a single clinical center from Jan 2014 to Dec 2022 were retrospectively included in this study. Baseline characteristics and short-term outcomes were compared between the PAS group and the non-PAS group. Univariate and multivariate logistic regression analyses were used to find risk factors for overall complications and major complications. A 1:1 ratio propensity score matching (PSM) was used to minimize the selection bias between the two groups. Statistical analysis was performed using SPSS (version 22.0) software.

RESULTS

A total of 5895 stage I-III CRC patients were included according to the inclusion and exclusion criteria. The PAS group had 1336 (22.7%) patients, and the non-PAS group had 4559 (77.3%) patients. After the PSM, there were 1335 patients in each group, and no significant difference was found in all baseline characteristics between the two groups (P > 0.05). After comparing the short-term outcomes, the PAS group had a longer operation time (before PSM, P < 0.01; after PSM, P < 0.01) and more overall complications (before PSM, P = 0.027; after PSM, P = 0.022) whether before or after PSM. In univariate and multivariate logistic regression analyses, PAS was an independent risk factor for overall complications (univariate analysis, P = 0.022; multivariate analysis, P = 0.029) but not for major complications (univariate analysis, P = 0.688).

CONCLUSION

Stage I-III CRC patients with PAS might experience longer operation time and have a higher risk of postoperative overall complications. However, it did not appear to significantly affect the major complications. Surgeons should take steps to improve surgical outcomes for patients with PAS.

Resleeve for failed laparoscopic sleeve gastrectomy: systematic review and meta-analysis

Despite excellent long-term results, insufficient weight loss, weight regain, and pathologic gastroesophageal reflux disease may require revisional procedures after laparoscopic sleeve gastrectomy (LSG). Resleeve gastrectomy (ReSG) for failed LSG, has been proposed as an alternative to more complex malabsorptive procedures. The aim of this systematic review and meta-analysis was to examine the current evidence on the therapeutic role and outcomes of ReSG for failed LSG. PubMed, EMBASE, and Web of Science data sets were consulted. A systematic review and Frequentist meta-analysis were performed. Ten studies published between 2010 and 2019 met the inclusion criteria for a total of 300 patients. The age of the patient population ranged from 20 to 66 years old and 80.5% were females. The elapsed time between the LSG and ReSG ranged from 9 to 132 months. The estimated pooled prevalence of postoperative leak and overall complications were 2.0% (95% confidence interval [CI] = .5%-4.7%) and 7.6% (95%CI = 3.1%-13.4%). The estimated pooled mean operative time and hospital length of stay were 51 minutes (95%CI = 49.4-52.6) and 3.3 days (95%CI = 3.13-3.51). The postoperative follow-up ranged from 12 to 36 months and the estimated pooled mean percentage excess weight loss was 61.46% (95%CI = 55.9-66.9). The overall mortality ranged from 0% to 2.2%. ReSG after failed LSG seems feasible and safe with acceptable postoperative leak rate, overall complications, and mortality. The effectiveness of ReSG in term of weight loss seems promising in the short-term but further studies are warranted to explore its effect on patients' quality of life, postoperative gastroesophageal reflux disease, and long-term weight loss.