Obesity as a risk factor for complications during laparoscopic surgery for renal cancer: multivariate analysis

BACKGROUND AND PURPOSE: A number of clinical variables are believed to be risk factors for complications of laparoscopic renal surgery. We reviewed our experience with laparoscopic surgery specifically for renal cancers to better clarify which clinical variables were significant risk factors. METHODS: Our laparoscopic experience with 210 cases of renal cancer from April 1999 through August 2004 was reviewed. Preoperative clinical characteristics were recorded. Complete information was available for 134 patients: 54 radical nephrectomies, 41 nephroureterectomies, 19 radiofrequency ablations, and 20 partial nephrectomies. Outcomes monitored included blood loss, length of hospital stay, conversion, blood transfusion, and intraoperative, minor postoperative, and major postoperative complications. Multivariate analysis was performed to determine whether any variable was a significant risk factor for adverse outcomes during or after laparoscopic surgery. RESULTS: The numbers of patients requiring operative conversion or blood transfusions were 6 (4.5%) and 20 (14.9%), respectively. Intraoperative, minor postoperative, and major postoperative complication occurred in 9 (6.7%), 22 (16.4%), and 11 (8.2%) patients, respectively. The year surgery was performed was inversely proportional to the incidence of minor postoperative complications, implying a protective association with the experience of the surgeon. On multivariate analysis, only body mass index (BMI) was found to be a significant risk factor for major postoperative complications with an odds ratio of 1.14 (P = 0.03). CONCLUSIONS: Laparoscopic surgery is safe, but with every unit increase in the BMI, the risk of a major complication increases by 14%.     

腹腔镜胆囊切除术并发症的危险因素分析

目的　探讨腹腔镜胆囊切除术 (LC)后并发症的危险因素。方法　回顾性分析 1991年3月至 2 0 0 3年 6月 11974例腹腔镜胆囊切除术并发症的临床资料 ,采用 χ2 检验和Logistic回归方法对可能导致LC并发症的 15个临床相关因素进行多因素回归分析。结果　LC术后并发症的发生率为1 896 % (2 2 7/11974 ) ,中转手术率为 2 389% (2 86 /11974 ) ,其中因发生并发症而中转开腹 6 5例 ,占2 2 7% (6 5 /2 86 )。Logistic回归分析显示 ,按其对并发症发生影响强弱程度 ,Calot三角粘连、病期、术者的手术经验、胆囊壁厚度 (B超 )、胆囊与周围粘连依次为导致LC并发症发生的主要危险因素。结论　加强医师的腹腔镜技术培训 ,正确掌握中转开腹的时机是降低LC手术严重并发症发生的有效措施。     

Impact of obesity on postoperative results of elective laparoscopic colectomy in sigmoid diverticulitis: a prospective study]

STUDY AIM: The aim of this prospective study was to assess the outcome of laparoscopic colectomy for sigmoid diverticulitis in normal weighted, overweighted and obese patients. PATIENTS AND METHOD: From January 1995 to December 2000, all patients (n = 77) undergoing an elective colectomy for sigmoid diverticulitis were included in the study. The patients were divided into three groups: group 1 (n = 29): normal weighted patients (BMI: 18-24.9); group 2 (n = 27): overweighted patients (BMI: 25.0-29.9); group 3 (n = 21): obese patients (BMI: 30.0-39.9). Comparison between these three groups was only made during the per and postoperative period. RESULTS: There were no differences in the three groups with regard to age, sex and ASA classification. Duration of operation did not differ between group 1 and 2 (187 vs 210 min, P = 0.6) but was shorter in group 1 than in group 3 (187 vs 247 min, P = 0.003). Conversion rate did not differ and was respectively in group 1, 2 and 3: 13.8, 14.8 and 14.3%. The postoperative period during which parenteral analgesics were required was not different for group 1 and 2 but was longer in group 3 than in group 1 (8.5 vs 5.7 days, p = 0.03). Morbidity rate was similar in group 1, 2 and 3: 15, 14 and 17%. There was no perioperative mortality. Duration of hospital stay was similar in the three groups. CONCLUSION: Data from the present study suggest that laparoscopic colectomy for sigmoid diverticulitis can be applied safely to overweighted and obese patients.     

Emergency laparoscopic management of perforated sigmoid diverticulitis: a promising alternative to more radical procedures

BACKGROUND: Classic emergency surgical management of complicated perforated sigmoid diverticulitis is based on the principle of a two-stage operation, with colon resection and temporary stoma (Hartmann's procedure). But the later second-stage operation can be technically difficult and can be associated with a significant morbidity rate. We argue that laparoscopy may be beneficial in such patients with peritonitis in terms of operative results and could facilitate later surgical management. STUDY DESIGN: We studied all consecutive patients with perforated sigmoid diverticulitis requiring emergency surgery between January 2000 and December 2004. RESULTS: Twenty-four patients underwent emergency laparoscopic management for perforated sigmoid diverticulitis. Nineteen patients (80%) were found to have a purulent or fecal diffuse peritonitis. No conversion and colostomy were necessary. The overall morbidity rate was 8%; 2 patients with pelvic abscesses required radiologic drainage. The median hospital stay was 12 days (range 7 to 35 days). Prophylactic sigmoid resection was performed by laparoscopy in all patients, with a conversion rate of 16%. CONCLUSIONS: Laparoscopic treatment of generalized peritonitis secondary to diverticulitis is feasible and safe and may be a promising alternative to more radical surgery in selected patients, avoiding fecal diversion and allowing a delayed elective laparoscopic sigmoid resection.     

Risk factors for the development of postoperative complications after bronchial sleeve resection for malignancy: a univariate and multivariate analysis

BACKGROUND: This study was designed to identify risk factors responsible for postoperative complications after bronchoplastic procedures. METHODS: Excluding sleeve pneumonectomies between January 1994 and December 2001, 108 patients underwent bronchoplastic procedures for bronchial malignancy. Prospectively documented data were age, gender, side, type of bronchial reconstruction, extended resection, histology, TNM stage, diseased lobe, and bronchial tumour occlusion. Cardiovascular (CV) risk factors included heart disease, arterial hypertension, cerebro-occlusive disease, peripheral artery disease of the lower extremities, diabetes mellitus, and abdominal aortic aneurysm. Patients were grouped according to the presence/absence of any CV risk factor and the absolute number of CV risk factors present (zero to four). Non-CV risk factors included neoadjuvant chemotherapy, alcoholism, lung disease, sleep apnea, history of recent pneumococcal sepsis, and repeat thoracotomy. Groups were assembled according to the presence or absence of any non-CV risk factor, neoadjuvant chemotherapy, and alcoholism. Respiratory risk factors included lung function and blood gas analysis. Groups were assembled according to the absolute number of respiratory risk factors in each person (zero to three) and the combination of respiratory and CV risk factors. Complications were defined as septic (pneumonia, empyema, brochopleural fistula, colitis) and aseptic. For univariate statistical analysis, t test, cross-tabulation, and chi2 test were used. All factors with a significance of p < 0.1 were entered into a binary backwards-stepwise logistic regression model. RESULTS: The combination of respiratory and CV risk factors (p = 0.012, OR = 0.165) was predictive for overall complications. Coronary artery disease (p = 0.02, OR = 0.062) and the combination of two respiratory risk factors (p = 0.008, OR = 0.062) were predictive for septic complications. Peripheral artery disease (p = 0.024, OR = 0.28), moderate (p = 0.01, OR = 0.13) and severe chronic obstructive pulmonary disease (p = 0.018, OR = 0.11), and extended resections (p = 0.003, OR = 0.017.) were predictive for aseptic complications. CONCLUSIONS: Comorbidity significantly influences the postoperative complication rate and is therefore crucial for evaluation of patients for bronchoplastic procedures. Different risk factors are responsible for the occurrence of septic and aseptic complications after bronchoplastic procedures.     

腹腔镜胆囊切除术并发症的危险因素及防治措施

目的探讨腹腔镜胆囊切除术(LC)并发症的危险因素及防治措施。方法回顾性分析293例接受LC患者的临床资料,详细分析发生并发症的高危因素及防治策略。结果 293例患者手术均成功,手术时间(39.56±5.47)min住院时间(7.56±1.73)d,无中转开腹手术病例。其中19例胆管损伤,4例胆漏,6例感染,1例出血,2例肠梗阻或内脏损伤及戳孔疝,并发症发生率10.92%。胆管损伤与谷丙氨酶水平、年龄、是否使用生长抑素无明显关联性(P>0.05),而与总胆红素水平、血浆白蛋白水平具有相关性(P<0..05)。结论 LC并发症的发生与手术适应证及操作不当外,与患者自身特征密切相关,故术中须强化规范性操作,并积极采取预防措施,以避免发生术后并发症。     

腹腔镜胆囊切除术并发症相关因素分析

目的 探讨导致腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)并发症发生的危险因素。方法 回顾分析我院自1991年3月-2003年6月间11974例腹腔镜胆囊切除术患者中发生并发症的临床资料,采用X~2检验和Logistic回归方法对可能导致腹腔镜胆囊切除术并发症发生的15个临床病理相关因素,进行多因素回归分析。结果 本组资料LC术后并发症的发生率为1.896％(227/11 974),中转手术率为2.386％(286/11 974),其中因发生并发症而中转开腹65例,占22.727％(65/286)。Logistic回归分析显示,按作用强度,Calot三角粘连、病期、手术经验、胆囊壁厚度(B超)、胆囊与周围粘连依次为导致腹腔镜胆囊切除术并发症发生的主要危险因素。结论 加强医师的腹腔镜技术培训,正确掌握LC相关危险因素是提高LC手术成功率的关键,正确掌握中转开腹的时机及开腹后处理方法,是降低LC手术严重并发症发生和死亡的有效措施。     

Predictors of intra- and postoperative complications in laparoscopic colorectal surgery: results of an expert survey

BACKGROUND: The decision which patient should undergo laparoscopic rather than open colorectal surgery depends on weighing its benefits against its complications. We explored which criteria prognosticate complications in a laparoscopic intervention by assembling experienced visceral surgeons' beliefs. METHODS: A two-round postal survey was conducted: 21 experts in laparoscopic surgery were contacted and asked to list (first round) and weigh (second round) indicators (scale 1-10) they believed predicted intra- or postoperative complications in patients undergoing laparoscopic colorectal surgery. Median ratings and interquartile ranges (IQRs) were calculated. Rates >or=6 and IQRs 相似文献   

急性胆囊炎早期腹腔镜治疗术后并发症的高危因素分析

目的:探讨急性胆囊炎早期行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后并发症的相关因素。方法:回顾分析2009年1月至2013年12月737例早期行LC的急性胆囊炎患者的临床资料,应用Logistic多因素回归分析术后并发症的相关危险因素。结果:LC术后15例(2.04%)早期出现并发症,6例再次手术治疗,9例保守治疗,均治愈。单因素分析显示早期LC术后并发症的发生与既往病程、是否为结石性胆囊炎、胆囊三角解剖变异、术者经验及出血量有关(P0.05),与性别、年龄、肥胖、合并内科疾病、胆囊颈结石嵌顿、胆囊萎缩及放置腹腔引流管无关(P0.05)。多因素分析显示既往病程、术者经验是早期LC术后并发症的独立危险因素(P0.05)。结论:急性胆囊炎患者LC术后早期容易发生并发症与既往病程较长、术者经验少相关,术者应加强训练,严格把握手术适应证及中转开腹指征。     

Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer

OBJECTIVE: This study aimed at: (1) documenting the evolution of surgical results of esophagectomy in a high-volume center, (2) identifying predictive factors of pulmonary complications and mortality, and (3) examining whether preoperative chemoradiation therapy would complicate postoperative recovery. SUMMARY BACKGROUND DATA: Pulmonary complications and mortality rate after esophagectomy remain substantial, and factors responsible have not been adequately studied. Neoadjuvant chemoradiation is widely used; it is hypothesized that this may lead to adverse postoperative outcome. METHODS: Prospectively collected data were used to analyze outcome in 421 patients with intrathoracic squamous cell esophageal cancer who underwent resection. Logistic regression analyses determined independent predictors of pulmonary complications and death. Two time periods were compared: period I (January 1990 to June 1995) and period II (July 1995 to December 2001). In the later period, neoadjuvant chemoradiation therapy was introduced. RESULTS: Transthoracic resections were carried out in 83% of patients. Neoadjuvant chemoradiation was given to 42% of patients in period II. Major pulmonary complications occurred in 15.9%, and were primarily responsible for 55% of hospital deaths. Thirty-day and hospital mortality rates were 1.4% and 4.8%, respectively. Logistic regression analysis identified age, operation duration, and proximal tumor location as risk factors for pulmonary complications, whereas advanced age and higher blood loss were predictive of mortality. Chemoradiation did not lead to worse outcome. When period I and II were compared, hospital mortality rate reduced from 7.8% to 1.1%, P = 0.001, with correspondingly less blood loss (median blood loss was 700 ml (range: 200-2700 (period I) and 450 ml (range: 100-7000) (period II), P < 0.01). CONCLUSION: A 1.1% mortality rate was achieved in the last 6 years of the study period. Preoperative chemoradiation did not result in worse outcome. Reduction in mortality rate correlated with decreased blood loss.