Multivariate Analysis Of Factors For Post-Operative Complications In Laparoscopic Assisted Colorectal Cancer Surgery

Objective: The aim of this study is to identify the predictive risk factors responsible for post-operative complications in patients undergoing laparoscopic assisted colorectal cancer surgery. Furthermore, this analysis has provided the necessary basis for the prevention and minimization of post-operative complications.Methods: 165 patients with colorectal cancer who received laparoscopic assisted surgery as from January 2007 till September 2009 in the Department of Gastro-intestinal Surgery of The First Affiliated Hospital of Chongqing Medical University were enrolled in this study. Information about the patients was collected from the case sheets to set up the database. The clinical factors such as gender, age, co-morbid diseases, American Society of Anesthesiologists grading (ASA), history of operation over abdominal region, TNM stage, operative time, intra-operative blood loss and conversion to open surgery were retrieved and considered for analysis. The following post-operative complications such as anastomotic leakage, bowel obstruction, incisional hernia, deep vein thrombosis, bleeding, pneumonia, hypoproteinemia, wound infection and wound dehiscence were also included. Univariate (Chi-square test and log-likelihood ratio test) and Multivariate logistic regression analysis were performed using SPSS 17.0 software for windows so as to find the relevant risk factors of post-operative complications.Results: The results of the Univariate analysis has shown that pulmonary disease(p=0.046)and operative time≥180 minutes (p=0.034) were associated with post-operative complications in laparoscopic-assisted colorectal cancer surgery. Multivariate analysis showed that pulmonary disease (adjusted odds ratio (OR): 4.474, 95% confidence interval (CI) 1.282～15.617) and operative time (adjusted odds ratio (OR): 5.018, 95% confidence interval (CI) 1.592～15.815) were the main independent risk factors which may affect the occurrence of post-operative complications.Conclusion: Pulmonary disease and operative time were found to be the independent risk factors of complications for laparoscopic surgery in colorectal cancer. Laparoscopic assisted colorectal surgery requires strict pre-operative evaluation, appropriate case selection so as to improve the tolerance of patients for pneumoperitoneum and surgery. Timely conversion of laparoscopically difficult cases and the surgeon's experience in laparoscopic surgery are primordial in order to shorten operative time. All these factors will contribute to achieve better clinical outcomes.