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Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Copyright © 2019 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
Variable | CD grades I, II (n=194) | CD grades III, IV (n=116) | P-value |
---|---|---|---|
Preoperative features | |||
Age (yr) | 60.5 (33–83) | 59 (32–85) | 0.545 |
Sex | |||
Female | 67 (65.5) | 38 (32.8) | 0.749 |
Male | 127 (65.5) | 78 (67.2) | |
ASA PS classification | |||
I, II | 176 (95.7) | 102 (94.4)a | 0.641 |
III, IV | 8 (4.3) | 6 (5.6) | |
Body mass index (kg/m2) | 23.78 (15.12–35.34) | 23.46 (16.45–30.52) | 0.415 |
Preoperative CEA level (ng/mL) | 1.83 (0.5–126.37) | 2.23 (0.5–125.70)b | 0.465 |
Underlying disease | |||
Hypertension | 63 (32.5) | 42 (36.2) | 0.502 |
Diabetes mellitus | 38 (19.6) | 21 (18.1) | 0.747 |
Heart disease | 14 (7.2) | 7 (6.0) | 0.689 |
Cerebrovascular disease | 8 (4.1) | 1 (0.9) | 0.980 |
Pulmonary disease | 12 (6.2) | 8 (6.9) | 0.805 |
Previous abdominal surgery | 57 (29.4) | 35 (30.2) | 0.883 |
Preoperative treatment | |||
Chemotherapy | 1 (0.5) | 1 (0.7) | 0.130 |
Radiotherapy | 0 (0) | 0 (0) | |
Chemoradiotherapy | 28 (14.4) | 27 (23.3) | |
Preoperative stenting | 2 (1.0) | 3 (2.6) | 0.293 |
Obstruction | 19 (9.8) | 23 (19.8) | 0.012 |
Perforation | 6 (3.1) | 9 (7.8) | 0.064 |
Intraoperative features | |||
Type of operation | |||
Right hemicolectomy | 57 (29.4) | 25 (21.6) | 0.211 |
Left hemicolectomy | 6 (3.1) | 7 (6.0) | |
Anterior resection | 32 (16.5) | 17 (14.7) | |
Low anterior resection | 92 (47.4) | 56 (48.3) | |
Other | 7 (3.6) | 11 (9.5) | |
Level of anastomosis | |||
Colon | 111 (57.2) | 60 (51.7) | 0.347 |
Rectum | 83 (42.8) | 56 (48.3) | |
Operative method | |||
Open surgery | 94 (48.5) | 82 (70.7) | < 0.001 |
Minimally invasive surgery | 100 (51.5) | 34 (29.3) | |
Emergency surgery | 7 (3.6) | 6 (5.2) | 0.506 |
Diverting stoma | 37 (19.1) | 20 (17.2) | 0.687 |
Operative time (min) | 160 (43–492) | 157 (64–490) | 0.827 |
Transfusion during operation | 6 (3.1) | 7 (6.0) | 0.211 |
Postoperative features | |||
Length of hospital stay | 12 (7-44) | 17 (8–85) | < 0.001 |
Pathologic T category | |||
0, 1, 2 | 83 (42.8) | 37 (31.9) | 0.057 |
3, 4 | 111 (57.2) | 79 (68.1) | |
Pathologic N category | |||
Negative | 122 (62.9) | 57 (49.1) | 0.018 |
Positive | 72 (37.1) | 59 (50.9) | |
Lymphovascular invasion | |||
Negative | 127 (65.5) | 70 (60.3) | 0.365 |
Positive | 67 (34.5) | 46 (39.7) | |
Perineural invasion | |||
Negative | 173 (89.2) | 102 (87.9) | 0.738 |
Positive | 21 (10.8) | 14 (12.1) | |
Tumor budding | |||
Negative | 124 (63.9) | 71 (61.2) | 0.633 |
Positive | 70 (36.1) | 45 (38.8) | |
Tumor size (cm) | 3.5 (0.1–12) | 4.0 (0.2–20) | 0.021 |
Harvested lymph nodes | 16 (0–58) | 17 (2–62) | 0.173 |
Adjuvant therapy | |||
Chemotherapy | 90 (46.4) | 65 (56.0) | 0.102 |
Radiotherapy | 0 (0) | 1 (0.9) | |
Chemoradiotherapy | 16 (8.2) | 12 (10.3) |
Type | Total | Clavien-Dindo classification |
||||
---|---|---|---|---|---|---|
I | II | IIIa | IIIb | IV | ||
Surgery-related | Minor complication 194 (62.6) | Major complication 116 (37.4) | ||||
Wound complication | 98 (31.6) | 20 (6.5) | 12 (3.9) | 63 (20.3) | 3 (1.0) | - |
Ileus | 61 (19.7) | 11 (3.5) | 40 (12.9) | 7 (2.3) | 2 (0.6) | 1 (0.3) |
Urinary retention | 58 (18.7) | 13 (4.2) | 45 (14.5) | - | - | - |
Anastomosis leakage | 37 (11.9) | - | 13 (4.2) | 1 (0.3) | 22 (7.1) | 1 (0.3) |
Postoperative bleeding | 27 (8.7) | 7 (2.3) | 16 (5.2) | - | 3 (1.0) | 1 (0.3) |
Chylous ascites | 13 (4.2) | 1 (0.3) | 12 (3.9) | - | - | - |
Intraabdominal fluid collection | 12 (3.9) | - | 4 (1.3) | 7 (2.3) | 1 (0.3) | - |
Rectovaginal fistula | 2 (0.6) | - | - | - | 2 (0.6) | - |
Bowel perforation | 2 (0.6) | - | - | - | 2 (0.6) | - |
Total | 310 (100) | 52 (16.8) | 142 (45.8) | 78 (25.2) | 35 (11.3) | 3 (1.0) |
Surgery-unrelated | ||||||
Pulmonary complication | 13 (54.2) | 6 (25.0) | 6 (25.0) | - | - | 1 (4.2) |
Urinary dysfunction | 4 (16.7) | - | 3 (12.5) | - | 1 (4.2) | - |
Neurologic complication | 3 (12.5) | 1 (4.2) | 2 (8.3) | - | - | - |
Cardiac complication | 2 (8.3) | - | 2 (8.3) | - | - | - |
Other | 2 (8.3) | - | 2 (8.3) | - | - | - |
Variable | CD grades I, II (n=194) | CD grades III, IV (n=116) | P-value |
---|---|---|---|
Preoperative features | |||
Age (yr) | 60.5 (33–83) | 59 (32–85) | 0.545 |
Sex | |||
Female | 67 (65.5) | 38 (32.8) | 0.749 |
Male | 127 (65.5) | 78 (67.2) | |
ASA PS classification | |||
I, II | 176 (95.7) | 102 (94.4) |
0.641 |
III, IV | 8 (4.3) | 6 (5.6) | |
Body mass index (kg/m2) | 23.78 (15.12–35.34) | 23.46 (16.45–30.52) | 0.415 |
Preoperative CEA level (ng/mL) | 1.83 (0.5–126.37) | 2.23 (0.5–125.70) |
0.465 |
Underlying disease | |||
Hypertension | 63 (32.5) | 42 (36.2) | 0.502 |
Diabetes mellitus | 38 (19.6) | 21 (18.1) | 0.747 |
Heart disease | 14 (7.2) | 7 (6.0) | 0.689 |
Cerebrovascular disease | 8 (4.1) | 1 (0.9) | 0.980 |
Pulmonary disease | 12 (6.2) | 8 (6.9) | 0.805 |
Previous abdominal surgery | 57 (29.4) | 35 (30.2) | 0.883 |
Preoperative treatment | |||
Chemotherapy | 1 (0.5) | 1 (0.7) | 0.130 |
Radiotherapy | 0 (0) | 0 (0) | |
Chemoradiotherapy | 28 (14.4) | 27 (23.3) | |
Preoperative stenting | 2 (1.0) | 3 (2.6) | 0.293 |
Obstruction | 19 (9.8) | 23 (19.8) | 0.012 |
Perforation | 6 (3.1) | 9 (7.8) | 0.064 |
Intraoperative features | |||
Type of operation | |||
Right hemicolectomy | 57 (29.4) | 25 (21.6) | 0.211 |
Left hemicolectomy | 6 (3.1) | 7 (6.0) | |
Anterior resection | 32 (16.5) | 17 (14.7) | |
Low anterior resection | 92 (47.4) | 56 (48.3) | |
Other | 7 (3.6) | 11 (9.5) | |
Level of anastomosis | |||
Colon | 111 (57.2) | 60 (51.7) | 0.347 |
Rectum | 83 (42.8) | 56 (48.3) | |
Operative method | |||
Open surgery | 94 (48.5) | 82 (70.7) | < 0.001 |
Minimally invasive surgery | 100 (51.5) | 34 (29.3) | |
Emergency surgery | 7 (3.6) | 6 (5.2) | 0.506 |
Diverting stoma | 37 (19.1) | 20 (17.2) | 0.687 |
Operative time (min) | 160 (43–492) | 157 (64–490) | 0.827 |
Transfusion during operation | 6 (3.1) | 7 (6.0) | 0.211 |
Postoperative features | |||
Length of hospital stay | 12 (7-44) | 17 (8–85) | < 0.001 |
Pathologic T category | |||
0, 1, 2 | 83 (42.8) | 37 (31.9) | 0.057 |
3, 4 | 111 (57.2) | 79 (68.1) | |
Pathologic N category | |||
Negative | 122 (62.9) | 57 (49.1) | 0.018 |
Positive | 72 (37.1) | 59 (50.9) | |
Lymphovascular invasion | |||
Negative | 127 (65.5) | 70 (60.3) | 0.365 |
Positive | 67 (34.5) | 46 (39.7) | |
Perineural invasion | |||
Negative | 173 (89.2) | 102 (87.9) | 0.738 |
Positive | 21 (10.8) | 14 (12.1) | |
Tumor budding | |||
Negative | 124 (63.9) | 71 (61.2) | 0.633 |
Positive | 70 (36.1) | 45 (38.8) | |
Tumor size (cm) | 3.5 (0.1–12) | 4.0 (0.2–20) | 0.021 |
Harvested lymph nodes | 16 (0–58) | 17 (2–62) | 0.173 |
Adjuvant therapy | |||
Chemotherapy | 90 (46.4) | 65 (56.0) | 0.102 |
Radiotherapy | 0 (0) | 1 (0.9) | |
Chemoradiotherapy | 16 (8.2) | 12 (10.3) |
Variable | Univariate analysis |
Multivariate analysis |
||||
---|---|---|---|---|---|---|
OR | 95% CI | P-value | OR | 95% CI | P-value | |
Age (> 59/ ≤ 59 yr) | 0.908 | 0.573–1.439 | 0.682 | |||
Sex (male/female) | 1.083 | 0.665–1.764 | 0.749 | |||
ASA PS classification (III, IV/I, II) | 1.294 | 0.437–3.835 | 0.642 | |||
BMI (> 23.6/ ≤ 23.6 kg/m2) | 0.871 | 0.550–1.381 | 0.558 | |||
Preoperative CEA (> 5.0/ ≤ 5.0 ng/mL) | 1.310 | 0.708–2.426 | 0.390 | |||
Underlying disease | ||||||
Hypertension | 1.180 | 0.728–1.914 | 0.502 | |||
Diabetes mellitus | 0.907 | 0.503–1.638 | 0.747 | |||
Heart disease | 0.826 | 0.323–2.109 | 0.689 | |||
Cerebrovascular disease | 0.202 | 0.025–1.638 | 0.134 | |||
Pulmonary disease | 1.123 | 0.445–2.835 | 0.805 | |||
Preoperative stenting | 2.549 | 0.420–15.484 | 0.309 | |||
Obstruction | 2.278 | 1.180–4.397 | 0.014 | 1.750 | 0.886–3.457 | 0.107 |
Perforation | 2.636 | 0.913–7.606 | 0.073 | |||
Operative method (open/MIS) | 2.566 | 1.573–4.184 | < 0.001 | 2.486 | 1.519–4.069 | < 0.001 |
Emergency surgery | 1.457 | 0.478–4.446 | 0.508 | |||
Operative time (> 160/ ≤ 160 min) | 0.973 | 0.614–1.541 | 0.906 | |||
Transfusion during operation | 2.012 | 0.659–6.140 | 0.219 | |||
Pathologic T category (3, 4/0, 1, 2) | 1.597 | 0.985–2.588 | 0.058 | |||
Pathologic N category (+/−) | 1.754 | 1.100–2.796 | 0.018 | 1.661 | 1.031–2.676 | 0.037 |
Lymphovascular invasion (+/−) | 1.246 | 0.774–2.004 | 0.365 | |||
Perineural invasion (+/−) | 1.131 | 0.551–2.321 | 0.738 | |||
Tumor budding (+/−) | 1.123 | 0.698–1.805 | 0.633 | |||
Tumor size (> 3.6/ ≤ 3.6 cm) | 1.180 | 0.744–1.870 | 0.481 | |||
Neoadjuvant therapy (+/−) | 2.737 | 1.397–5.364 | 0.003 | 1.519 | 0.808–2.858 | 0.195 |
Pathologic T category (3, 4/0, 1, 2) | Univariate analysis |
Multivariate analysis |
||||
---|---|---|---|---|---|---|
OR | 95% CI | P-value | OR | 95% CI | P-value | |
Age (> 59/ ≤ 59 yr) | 0.635 | 0.362–1.114 | 0.114 | |||
Sex (male/female) | 0.583 | 0.336–1.010 | 0.054 | |||
ASA PS classification (III, IV/I, II) | 1.385 | 0.430–4.460 | 0.585 | |||
BMI (> 23.6/ ≤ 23.6 kg/m2) | 0.882 | 0.509–1.527 | 0.653 | |||
Preoperative CEA (> 0.5/ ≤ 5.0 ng/mL) | 1.842 | 0.975–3.483 | 0.060 | |||
Underlying disease | ||||||
Hypertension | 0.757 | 0.409–1.401 | 0.376 | |||
Diabetes mellitus | 0.464 | 0.184–1.168 | 0.103 | |||
Heart disease | 0.531 | 0.129–2.185 | 0.381 | |||
Cerebrovascular disease | 2.407 | 0.749–7.731 | 0.140 | |||
Pulmonary disease | 0.931 | 0.290–2.988 | 0.904 | |||
Preoperative stenting | 3.012 | 0.731–12.416 | 0.127 | |||
Obstruction | 1.013 | 0.456–2.250 | 0.974 | |||
Perforation | 4.608 | 2.159–9.837 | < 0.001 | 4.436 | 2.024–9.722 | < 0.001 |
Operative method (open/MIS) | 1.563 | 0.873–2.797 | 0.133 | |||
Emergency surgery | 3.218 | 1.372–7.549 | 0.007 | 0.927 | 0.350–2.456 | 0.879 |
Operative time (> 160/ ≤ 160 min) | 1.693 | 0.965–2.971 | 0.067 | |||
Transfusion during operation | 2.970 | 1.178–7.486 | 0.021 | 1.635 | 0.501–5.338 | 0.416 |
Pathologic T category (3, 4/0, 1, 2) | 3.288 | 1.600–6.7155 | 0.001 | 1.133 | 0.446–2.880 | 0.793 |
Pathologic N category (+/−) | 3.361 | 1.860–6.074 | < 0.001 | 1.787 | 0.824–3.876 | 0.142 |
Lymphovascular invasion (+/−) | 3.365 | 1.907–5.939 | < 0.001 | 1.072 | 0.518–2.217 | 0.852 |
Perineural invasion (+/−) | 5.665 | 3.183–10.082 | < 0.001 | 3.249 | 1.779–5.934 | < 0.001 |
Tumor budding (+/−) | 4.076 | 2.276–7.300 | < 0.001 | 4.606 | 2.422–8.758 | < 0.001 |
Tumor size (> 3.6/ ≤ 3.6) | 1.156 | 0.667–2.004 | 0.605 | |||
Neoadjuvant therapy (+/−) | 2.286 | 1.227–4.092 | 0.005 | 4.177 | 2.231–7.819 | < 0.001 |
Adjuvant therapy (+/−) | 2.348 | 1.205–4.576 | 0.012 | 0.782 | 0.333–1.834 | 0.572 |
CD (III, IV/I, II) | 1.273 | 0.731–2.215 | 0.394 |
Values are presented as number (%).
Values are presented as median (range) or number (%). ASA PS, American Society of Anesthesiologists physical status; CEA, carcinoembryonic antigen; CD, Clavien-Dindo classification. Not available (N/A) 18 cases. N/A 12 cases.
OR, odds ratio; CI, confidence interval; ASA PS, American Society of Anesthesiologists physical status; BMI, body mass index; CEA, carcinoembryonic antigen; MIS, minimally invasive surgery.
OR, odds ratio; CI, confidence interval; ASA PS, American Society of Anesthesiologists physical status; BMI, body mass index; CEA, carcinoembryonic antigen; MIS, minimally invasive surgery; CD, Clavien-Dindo classification.