結直腸癌術后并發癥的風險預測模型_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

高銘 ¹ , 戴剛 ¹ , 蔡卓瑋 ¹ , 蔡一亭 ¹ ,  費哲為 ^1,2

1. ;
2. ;

Corresponding?author：

費哲為, Email: zheweifei2013@sina.cn

Keywords：

結直腸癌; 術后并發癥; 風險預測模型

DOI：

10.7507/1007-9424.202004122

Video：

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目的探討與結直腸癌術后并發癥相關的主要危險因素并建立風險預測模型。方法回顧性收集 2015 年 1 月至 2016 年 12 月期間于新華醫院崇明分院、堡鎮醫院及廟鎮醫院行結直腸癌手術且符合本研究納入條件患者的臨床病理資料，分析結直腸癌術后并發癥發生的危險因素并建立風險預測模型，同時采用回代樣本進行驗證。結果本研究共納入符合條件的結直腸癌手術患者 450 例，術后發生并發癥 67 例，并發癥發生率為 14.9%。單因素分析結果顯示，患者的年齡高、合并糖尿病、合并心腦血管疾病、合并慢性阻塞性肺炎、無術前化療、ASA 分級高、手術持續時間長、TNM 分期晚、腫瘤分化程度低、主刀手術例數少、術中輸血及術前營養不良這 12 個因素與結直腸癌根治術后并發癥發生有關（P<0.05）；進一步行多因素 logistic 回歸分析結果顯示，這 12 個因素是結直腸癌根治術后并發癥發生的危險因素（P<0.05），通過將包括這 12 個危險因素與常數項建立的 logistic 回歸風險模型判斷結直腸癌術后并發癥的靈敏度和特異度分別為 68.7%（46/67）和84.9%（325/383）；采用 40 例回代樣本進行驗證，此模型判斷結直腸癌術后并發癥的靈敏度和特異度分別為 66.7%（18/27）和 84.6%（11/13）。結論本研究根據多因素 logistic 回歸分析得出了 12 項結直腸癌術后并發癥發生獨立的危險因素并以此建立的回歸風險模型能夠較為準確地預測結直腸癌術后的并發癥發生率。

Citation： 高銘, 戴剛, 蔡卓瑋, 蔡一亭, 費哲為. 結直腸癌術后并發癥的風險預測模型. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(2): 252-255. doi: 10.7507/1007-9424.202004122 Copy

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5.	于善海, 李德生, 伊力亞爾·夏合丁, 等. 食管癌切除術后并發癥多因素Logistic回歸分析及風險模型建立. 世界華人消化雜志, 2011, 19(34): 3508-3513.
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9.	Couwenberg AM, Burbach MJ, Smits AB, et al. The impact of retractor SPONGE-assisted laparoscopic surgery on duration of hospital stay and postoperative complications in patients with colorectal cancer (SPONGE trial): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 132.
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11.	Casal Nú?ez JE, Vigorita V, Ruano Poblador A, et al. Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol, 2017, 23(9): 1712-1719.
12.	Sakari T, Sj?dahl R, P?hlman L, et al. Role of icodextrin in the prevention of small bowel obstruction. Safety randomized patients control of the first 300 in the ADEPT trial. Colorectal Dis, 2016, 18(3): 295-300.
13.	McSorley ST, Horgan PG, McMillan DC. The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol, 2016, 97: 168-177.
14.	Yaegashi M, Otsuka K, Kimura T, et al. Transumbilical abdominal incision for laparoscopic colorectal surgery does not increase the risk of postoperative surgical site infection. Int J Colorectal Dis, 2017, 32(5): 715-722.
15.	Yamada T, Okabayashi K, Hasegawa H, et al. Age, preoperative subcutaneous fat area, and open laparotomy are risk factors for incisional hernia following colorectal cancer surgery. Ann Surg Oncol, 2016, 23(Suppl 2): S236-S241.
16.	Floodeen H, Hallb??k O, Hagberg LA, et al. Costs and resource use following defunctioning stoma in low anterior resection for cancer-A long-term analysis of a randomized multicenter trial. Eur J Surg Oncol, 2017, 43(2): 330-336.
17.	McSorley ST, Khor BY, MacKay GJ, et al. Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer: A pragmatic study. Medicine (Baltimore), 2017, 96(7): e6133.
18.	Anderin K, Gustafsson UO, Thorell A, et al. The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer. Eur J Surg Oncol, 2016, 42(6): 788-793.
19.	Gietelink L, Wouters MW, Bemelman WA, et al. Reduced 30-day mortality after laparoscopic colorectal cancer surgery: A population based study from the Dutch Surgical Colorectal Audit (DSCA). Ann Surg, 2016, 264(1): 135-140.
20.	Watt DG, McSorley ST, Park JH, et al. A postoperative systemic inflammation score predicts short- and long-term outcomes in patients undergoing surgery for colorectal cancer. Ann Surg Oncol, 2017, 24(4): 1100-1109.
21.	Hu WH, Chen HH, Lee KC, et al. Assessment of the addition of hypoalbuminemia to ACS-NSQIP surgical risk calculator in colorectal cancer. Medicine (Baltimore), 2016, 95(10): e2999.

1. Abraha I, Serraino D, Giovannini G, et al. Validity of ICD-9-CM codes for breast, lung and colorectal cancers in three Italian administrative healthcare databases: a diagnostic accuracy study protocol. BMJ Open, 2016, 6(3): e010547.
2. Chang YT, Huang MY, Yeh YS, et al. A prospective study of comparing multi-gene biomarker chip and serum carcinoembryonic antigen in the postoperative surveillance for patients with stage Ⅰ?Ⅲ colorectal cancer. PLoS One, 2016, 11(10): e0163264.
3. 中華醫學會呼吸病學分會. 醫院獲得性肺炎診斷和治療指南(草案). 中華結核和呼吸雜志, 1999, 22(4): 201-203.
4. Dilworth JP, White RJ. Postoperative chest infection after upper abdominal surgery: an important problem for smokers. Respir Med, 1992, 86(3): 205-210.
5. 于善海, 李德生, 伊力亞爾·夏合丁, 等. 食管癌切除術后并發癥多因素Logistic回歸分析及風險模型建立. 世界華人消化雜志, 2011, 19(34): 3508-3513.
6. Kim JY, Park IJ, Kim HR, et al. Post-pulmonary metastasectomy prognosis after curative resection for colorectal cancer. Oncotarget, 2017, 8(22): 36566-36577.
7. Samuelsson KS, Egenvall M, Klarin I, et al. Inappropriate drug use in elderly patients is associated with prolonged hospital stay and increased postoperative mortality after colorectal cancer surgery: a population-based study. Colorectal Dis, 2016, 18(2): 155-162.
8. 許釗榮, 池畔. 腹腔鏡與開腹結直腸癌根治術后并發癥發生率的比較. 中華胃腸外科雜志, 2012, 15(8): 810-813.
9. Couwenberg AM, Burbach MJ, Smits AB, et al. The impact of retractor SPONGE-assisted laparoscopic surgery on duration of hospital stay and postoperative complications in patients with colorectal cancer (SPONGE trial): study protocol for a randomized controlled trial. Trials, 2016, 17(1): 132.
10. Matsuda M, Tsuruta M, Hasegawa H, et al. Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction. Surg Today, 2016, 46(5): 613-620.
11. Casal Nú?ez JE, Vigorita V, Ruano Poblador A, et al. Presacral venous bleeding during mobilization in rectal cancer. World J Gastroenterol, 2017, 23(9): 1712-1719.
12. Sakari T, Sj?dahl R, P?hlman L, et al. Role of icodextrin in the prevention of small bowel obstruction. Safety randomized patients control of the first 300 in the ADEPT trial. Colorectal Dis, 2016, 18(3): 295-300.
13. McSorley ST, Horgan PG, McMillan DC. The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol, 2016, 97: 168-177.
14. Yaegashi M, Otsuka K, Kimura T, et al. Transumbilical abdominal incision for laparoscopic colorectal surgery does not increase the risk of postoperative surgical site infection. Int J Colorectal Dis, 2017, 32(5): 715-722.
15. Yamada T, Okabayashi K, Hasegawa H, et al. Age, preoperative subcutaneous fat area, and open laparotomy are risk factors for incisional hernia following colorectal cancer surgery. Ann Surg Oncol, 2016, 23(Suppl 2): S236-S241.
16. Floodeen H, Hallb??k O, Hagberg LA, et al. Costs and resource use following defunctioning stoma in low anterior resection for cancer-A long-term analysis of a randomized multicenter trial. Eur J Surg Oncol, 2017, 43(2): 330-336.
17. McSorley ST, Khor BY, MacKay GJ, et al. Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer: A pragmatic study. Medicine (Baltimore), 2017, 96(7): e6133.
18. Anderin K, Gustafsson UO, Thorell A, et al. The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer. Eur J Surg Oncol, 2016, 42(6): 788-793.
19. Gietelink L, Wouters MW, Bemelman WA, et al. Reduced 30-day mortality after laparoscopic colorectal cancer surgery: A population based study from the Dutch Surgical Colorectal Audit (DSCA). Ann Surg, 2016, 264(1): 135-140.
20. Watt DG, McSorley ST, Park JH, et al. A postoperative systemic inflammation score predicts short- and long-term outcomes in patients undergoing surgery for colorectal cancer. Ann Surg Oncol, 2017, 24(4): 1100-1109.
21. Hu WH, Chen HH, Lee KC, et al. Assessment of the addition of hypoalbuminemia to ACS-NSQIP surgical risk calculator in colorectal cancer. Medicine (Baltimore), 2016, 95(10): e2999.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

結直腸癌術后并發癥的風險預測模型

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