Analysis Of Causes And Risk Factors For Unplanned Reoperation After Laparoscopic Colorectal Cancer And Construction Of A Nomogram Prediction Model

Objective: The aim of this study is to investigate in depth the current situation,causes and possible risk factors for unplanned reoperation in patients after laparoscopic colorectal cancer surgery,and to construct a columnar graph prediction model based on this information to provide clinicians with a valid reference for decision making.Methods: Retrospective collection and analysis of 2241 patients who underwent laparoscopic colorectal cancer surgery at the Colorectal Surgery Center of Sichuan Cancer Hospital from January 2017 to December 2020,with55 patients undergoing unplanned reoperation.They were divided into two groups according to whether unplanned reoperation occurred after radical laparoscopic colorectal cancer surgery.Patient data were collected through the hospital case system,and data recorded for each patient included: basic information: gender,age,BMI,whether there was a history of diabetes,hypertension and cardiovascular disease,history of previous abdominal surgery,haemoglobin,platelets and albumin;tumour-related information: tumour site,history of preoperative radiotherapy,history of preoperative chemotherapy,tumour TNM stage;surgical information: ASA score,length of surgery and intraoperative Other information: length of hospital stay and hospital costs.Univariate analysis of the respective variables was performed using SPSS 26.0,and significant indicators(p<0.05)were included in logistic multi-factor regression analysis.When p<0.05,this suggested that the variables were statistically significant,indicating that they were independent risk factors.Therefore,we determined the relationship between the unplanned reoperation group and the control group by comparing their clinical characteristics.Using R software and the rms package,each independent risk factor was analysed and a column line graph prediction model was developed,which was tested internally to ensure the accuracy of the model.Results: From January 2017 to December 2020,2,241 laparoscopic radical colorectal cancer operations were performed at the Colorectal Surgery Center of Sichuan Cancer Hospital.55 patients required reoperation after surgery,with an incidence of 2.45 %,of which 3 patients required more than two repeat operations.The incidence of unplanned reoperations was statistically composed of anastomotic leakage(25 cases,45.46%),bowel obstruction(22cases,40%),bleeding(3 cases,5.45%),abdominal infection(3 cases,5.45%),abdominal wall incision dehiscence(1 case,1.82%)and abdominal drainage tube impaction(1 case,1.82%).There were no postoperative deaths and all patients eventually improved.Unplanned reoperations resulted in longer hospital stays and higher hospital costs for patients(p<0.005).After analysis,male patients,patients with cardiovascular disease,patients with hypoproteinemia and patients who had undergone abdominal surgery were found to be independent risk factors for unplanned reoperation after laparoscopic radical colorectal cancer surgery.A risk prediction model was developed from the independent risk factors and the calibration curve fitted well with an area under the subject operating characteristic curve(ROC)of AUC = 0.781.This indicates that the model has good predictive value.Conclusion: The main causes of unplanned reoperation after laparoscopic colorectal cancer surgery are anastomotic leak and bowel obstruction.There is a greater need to focus on and prevent unplanned reoperations in male patients,patients with cardiovascular disease,patients with hypoproteinemia and patients who have undergone previous abdominal surgery.Risk prediction models based on risk factors can effectively identify those at high risk of unplanned reoperation after laparoscopic colorectal cancer surgery.