Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center

Estimation of Physiologic Ability and Surgical Stress scoring system for predicting complications following abdominal surgery: A meta-analysis spanning 2004 to 2022

BACKGROUND

Postoperative complications remain a paramount concern for surgeons and healthcare practitioners.

AIM

To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system's efficacy in predicting postoperative complications following abdominal surgery.

METHODS

A systematic search of published studies was conducted, yielding 17 studies with pertinent data. Parameters such as preoperative risk score (PRS), surgical stress score (SSS), comprehensive risk score (CRS), postoperative complications, postoperative mortality, and other clinical data were collected for meta-analysis. Forest plots were employed for continuous and binary variables, with χ2 tests assessing heterogeneity (P value).

RESULTS

Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications [mean difference and 95% confidence interval (CI) of PRS: 0.10 (0.05-0.15); SSS: 0.04 (0.001-0.08); CRS: 0.19 (0.07-0.31)]. Following the exclusion of low-quality studies, results remained valid with no discernible heterogeneity. Subgroup analysis indicated that variations in sample size and age may contribute to heterogeneity in CRS analysis. Binary variable meta-analysis demonstrated a correlation between high CRS and increased postoperative complication rates [odds ratio (OR) (95%CI): 3.01 (1.83-4.95)], with a significant association observed between high CRS and postoperative mortality [OR (95%CI): 15.49 (3.75-64.01)].

CONCLUSION

In summary, postoperative complications in abdominal surgery, as assessed by the E-PASS scoring system, are consistently linked to elevated PRS, SSS, and CRS scores. High CRS scores emerge as risk factors for heightened morbidity and mortality. This study establishes the accuracy of the E-PASS scoring system in predicting postoperative morbidity and mortality in abdominal surgery, underscoring its potential for widespread adoption in effective risk assessment.

Effect of low-level creatinine clearance on short-term postoperative complications in patients with colorectal cancer

Background

Renal function is closely related to cancer prognosis. Since preoperative renal insufficiency has been identified as a risk factor for postoperative complications, this study aimed to investigate the effect of preoperative creatinine clearance rate (CrCl) on short-term prognosis of patients undergoing colorectal surgery.

Methods

A retrospective analysis was conducted of the electronic health records of 526 adult patients who underwent elective colorectal cancer (CRC) surgery from September 2014 to February 2019 at the First Affiliated Hospital of Wenzhou Medical University. Cases were divided into two groups according to CrCl level and clinical variables were compared. Risk factors associated with postoperative complications were evaluated through univariate and multivariate logistic regression analyses.

Results

A total of 526 patients met the inclusion criteria. The overall rate of postoperative complications was 28.14%. Overall, the incidence of postoperative complications was significantly higher in the low CrCl patients. A low-level CrCl, multi-organ combined resection, and Charlson comorbidity index (CCI) were independent risk factors for short-term complications in patients with CRC. However, a low CrCl was identified as an independent risk factor for short-term postoperative complications in elderly, but not young patients in a subgroup analysis.

Conclusions

Preoperative low-level CrCl, multi-organ combined resection, and CCI were significant risk factors of postoperative complications in CRC patients. Preoperative low-level CrCl and multi-organ combined resection has a poor prognostic impact for elderly patients with CRC. These findings should have important implications for health care decision-making among patients with CRC who are at higher risk for post-operative complications.

Elective robotic partial colon and rectal resections: series of 170 consecutive robot procedures involving the Da Vinci Xi robot by a community general surgeon

Robotic colorectal procedures may overcome the disadvantages of laparoscopic surgery. While the literature has multiple studies from specialized centers, experience from general surgeons is minimal. The purpose of this case series is to review elective partial colon and rectal resections by a general surgeon. 170 consecutive elective partial colon and rectal resections were reviewed. The cases were analyzed by type of procedure and total cases. The outcomes analyzed were procedure time, conversion rate, length of stay, complications, anastomotic leak, and node retrieval in the cancer cases. There were 71 right colon resections, 13 left colon resections, 44 sigmoid colon resection sand 42 low anterior resections performed. The mean length of procedure was 149 min. The conversion rate was 2.4%. The mean length of stay was 3.5 days. The percentage of cases one or more complications was 8.2%. There were 3 anastomotic leaks out of 159 anastomoses (1.9%). The mean lymph node retrieval was 28.4 for the 96 cancer cases. Robot partial colon and rectal resections on the Da Vinci Xi robot can be completed safely and efficiently by a community general surgeon. Prospective studies are needed to demonstrate reproducibility by community surgeons performing robot colon resections.