Risk factors and prognostic significance of postoperative complications following lateral pelvic lymph node dissection for rectal cancer: results of the multicenter lateral node study in China.

Abstract

Total mesorectal excision (TME) plus lateral pelvic lymph node (LPN) dissection (LPND) is a technically complex and challenging procedure with higher morbidity than TME alone. We aimed to investigate the risk factors for postoperative complications after TME+LPND, and the impact of complications on patient prognosis. A total of 387 rectal cancer patients with clinical LPN metastasis (LPNM) who underwent TME+LPND at three institutions affiliated with the Chinese Lateral Node Collaborative Group were included. Logistic regression models were used to identify the risk factors for post-surgical complications, and the log-rank test was used to compare the prognosis. Severe complications were described as grade III-V. The incidence rates of overall complications and severe complications after TME+LPND were 15.2% (59/387) and 7.8% (30/387), respectively. Multivariate analysis showed that a duration of operation ≥260min was an independent risk factor for both overall (odds ratio [OR]=3.03, 95% confidence interval [CI]=1.57-5.85, P=0.001) and severe postoperative complications (OR=2.67, 95% CI=1.06-6.73, P=0.037). The development of overall postoperative complications (P=0.114) and severe postoperative complications (P=0.298) had no significant impact on the overall survival. However, patients with overall complications (P=0.015) or severe complications (P=0.031) with a postoperative hospital stay >30days had significantly an overall worse survival. A surgical duration of ≥260min is a significant risk factor for both overall and severe postoperative complications after TME+LPND for middle-low rectal cancer. Furthermore, the development of overall complications or severe complications that require a postoperative hospital stay >30days significantly worsens the prognosis.