Citation: | Sun Feng, Huang Yibo, Sun Yan, et al. Application value of Clavien‑Dindo classification and comprehensive complication index in evaluating early postoperative complications for radical gastric cancer surgery[J]. Chinese Journal of Digestive Surgery, 2024, 23(10): 1338-1344. DOI: 10.3760/cma.j.cn115610-20240904-00408 |
To investigate the application value of Clavien⁃Dindo classification (CDC) and comprehensive complication index (CCI) in evaluating early postoperative complications for radical gastric cancer surgery.
The retrospective cohort study was conducted. The clinicopathological data of 1 484 patients who underwent radical gastric cancer surgery in Affiliated Drum Tower Hospital, Medical School of Nanjing University from January 2016 to December 2018 were collected. There were 1 086 males and 398 females, aged (60±17)years. The early complica-tions of patients were classified by the CDC and the CCI was calculated. Measurement data with normal distribution were represented as Mean±SD. Count data are expressed as absolute numbers. Univariate analysis was performed using the chi-square test. Multivariate analysis was conducted using Logistic regression analysis. Correlation analysis between CDC, CCI and duration of postopera-tive hospital stay, total hospital expenses was performed using the Spearman rank correlation. Multiple linear regression analysis was conducted to compare the correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses.
(1) Distribution of early postoperative complications by CDC and CCI. Among the 1 484 patients, 432 patients developed early postoperative complications, of which 322 cases had a single complication, and 110 cases had multiple complications. Among the 432 patients with complications, the numbers of patients with grades Ⅰ, Ⅱ, Ⅲa, Ⅲb, Ⅳ, and Ⅴ of CDC were 231, 137, 45, 13, 3, and 3 cases, respectively. The CCI in the 432 patients with complications was 17.2±11.7, with peak values of 8.7 and 20.9. (2) Analysis of factors influencing early postoperative complications in patients undergoing radical gastric cancer surgery. Results of multivariate analysis showed that female, age ≥70 years, and preoperative serum albumin <35 g/L were independent risk factors for early postoperative complications in patients undergoing radical gastric cancer surgery (odds ratios=1.391, 1.535, 1.521, 95% confidence intervals as 1.083-1.786, 1.187-1.985, 1.055-2.192, P<0.05). (3) Correlation analysis between CDC, CCI and duration of postoperative hospital stay, total hospital expenses. Among the 432 patients with post-operative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay (r=0.574, 0.576, P<0.05), and both were positively correlated with total hospital expenses (r=0.413, 0.438, P<0.05). Among the 110 patients with multiple postoperative complications, both CDC and CCI were positively correlated with duration of postoperative hospital stay (r=0.514, 0.537, P<0.05), and both were positively correlated with total hospital expenses (r=0.427, 0.474, P<0.05). (4) Regression analysis between CDC, CCI, and duration of postoperative hospital stay, total hospital expenses. Multiple linear regression analysis of duration of postoperative hospital stay showed that CDC ≥grade 3, age ≥70 years, preoperative C-reactive protein ≥10 g/L, and American Society of Anesthesiology (ASA) classification ≥grade 3 were associated with prolonged duration of postopera-tive hospital stay. The higher CCI indicated longer duration of postoperative hospital stay. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.467 versus 0.212). The regression analysis of total hospital expenses showed that CDC ≥grade 3, age ≥70 years, preoperative serum albumin <35 g/L, ASA classification ≥grade 3, and pathological stage Ⅲ-Ⅳ increased total hospital expenses, while gender of female reduced the expenses. The higher CCI indicated higher hospital expenses. The standard b value of CCI was higher than that of CDC ≥grade 3 (0.449 versus 0.061).
Both the CDC and CCI can effectively reflect the severity of postoperative complica-tions following radical gastric cancer surgery. Compared to the CDC, the CCI can better predict post-operative hospital stay and total hospital expenses.
[1] |
SungH, FerlayJ, SiegelRL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2021,71(3):209‑249. DOI: 10.3322/caac.21660.
|
[2] |
GomesNV, PolutakA, SchindlerC, et al. Discrepancy in reporting of perioperative complications: a retrospective observational study[J]. Ann Surg,2023,278(5):e981‑e987. DOI: 10.1097/SLA.0000000000005807.
|
[3] |
SuH, BuZ. Research progress of minimally invasive surgery for gastric cancer[J]. Chin J Cancer Res,2023,35(4):343‑353. DOI: 10.21147/j.issn.1000-9604.2023.04.02.
|
[4] |
DegerliMS, CanturkAO, BozkurtH, et al. Systematic assess-ment of complications after laparoscopic colorectal surgery for advanced colorectal cancer: A retrospective study using Clavien‑Dindo classification, 5‑year experience[J]. Malawi Med J,2022,34(1):49‑52. DOI: 10.4314/mmj.v34i1.9.
|
[5] |
GianiA, CiprianiF, FamularoS, et al. Performance of comprehensive complication index and Clavien‑Dindo complication scoring system in liver surgery for hepatocellular carcinoma[J]. Cancers (Basel),2020,12(12):3868. DOI:10. 3390/cancers12123868.
|
[6] |
VallurS, DuttaA, ArjunAP. Use of Clavien‑Dindo classification system in assessing head and neck surgery complications[J]. Indian J Otolaryngol Head Neck Surg,2020,72(1):24‑29. DOI: 10.1007/s12070-019-01718-7.
|
[7] |
朱易豪,王飞,赵怡,等.术后并发症标准化报告及评估工具的研究进展[J].四川大学学报:医学版,2022,53(2):342-348. DOI: 10.12182/20220360506.
|
[8] |
VetterleinMW, KlemmJ, GildP, et al. Improving estimates of perioperative morbidity after radical cystectomy using the European Association of Urology Quality Criteria for Standardized Reporting and introducing the comprehensive complication index[J]. Eur Urol,2020,77(1):55‑65. DOI: 10.1016/j.eururo.2019.08.011.
|
[9] |
SlankamenacK, NederlofN, PessauxP, et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials[J]. Ann Surg,2014,260(5):757‑763. DOI: 10.1097/SLA.0000000000000948.
|
[10] |
HuangH, ZhangZ, HaoH, et al. The comprehensive complication index is more sensitive than the Clavien‑Dindo classification for grading complications in elderly patients after radical cystectomy and pelvic lymph node dissection: Implementing the European Association of Urology guideline[J]. Front Oncol,2022,12:1002110. DOI:10.3389/fonc. 2022.1002110.
|
[11] |
KowalewskiKF, MüllerD, MühlbauerJ, et al. The comprehensive complication index (CCI): proposal of a new repor-ting standard for complications in major urological surgery[J]. World J Urol,2021,39(5):1631‑1639. DOI: 10.1007/s00345-020-03356-z.
|
[12] |
吴云云,郎建华,吴建忠,等.胃癌术后肺部感染列线图预测模型的构建[J].中国现代普通外科进展,2023,26(12):951-955. DOI: 10.3969/j.issn.1009-9905.2023.12.006.
|
[13] |
王衡兵,胡立平,吴家伟,等.Roux-en-Y术式重建消化道对胃癌的疗效及术后并发症的影响[J].中国现代普通外科进展,2022,25(5):394-396. DOI:10.3969/j.issn.1009-9905.2022. 05.015.
|
[14] |
伍德福,方心安,鲁修明,等.腹腔镜辅助胃癌D2根治术治疗老年进展期胃癌患者近期效果及远期预后观察[J].临床误诊误治,2022,35(5):45-47. DOI:10.3969/j.issn.1002-3429. 2022.05.014.
|
[15] |
陈秀秀,蔡乐男,卢建波,等.经胸膜外间隙导管注入局麻药对胸腔镜术后镇痛效果、并发症的影响[J].临床误诊误治,2023,36(2):138-142,148. DOI:10.3969/j.issn.1002-3429. 2023.02.029.
|
[16] |
魏世东,孙劲文.腹腔镜胃癌根治术后非计划二次手术的危险因素分析[J].局解手术学杂志,2022,31(3):212-216. DOI: 10.11659/jjssx.08E021008.
|
[17] |
De La Plaza Llamas R, Ramia ÁngelJM, BellónJM, et al. Clinical validation of the comprehensive complication index as a measure of postoperative morbidity at a surgical depart-ment:a prospective study [J]. Ann Surg,2018,268(5):838-844.
|
[18] |
DumitraTC, TrepanierM, FioreJFJr, et al. The relationship of two postoperative complication grading schemas with postoperative quality of life after elective colorectal surgery[J]. Surgery,2019,166(4):663‑669. DOI:10.1016/j.surg. 2019.05.058.
|
[19] |
ZhuF, FengD, ZhangT, et al. Toward a more sensitive endpoint for assessing postoperative complications in patients with inflammatory bowel disease:a comparison between comprehensive complication index (CCI) and Clavien-Dindo classification (CDC) [J]. J Gastrointest Surg,2018,22(9):1593‑1602. DOI: 10.1007/s11605-018-3786-x.
|
[20] |
DumitraS, O′LearyM, RaoofM, et al. The comprehensive complication index: a new measure of the burden of complications after hyperthermic intraperitoneal chemotherapy[J]. Ann Surg Oncol,2018,25(3):688‑693. DOI: 10.1245/s10434-017-6157-z.
|
[21] |
MaG, CaoH, WeiR, et al. Comparison of the short‑term clinical outcome between open and minimally invasive esophagectomy by comprehensive complication index[J]. J Cancer Res Ther,2018,14(4):789‑794. DOI: 10.4103/jcrt.JCRT_48_18.
|
[22] |
ShimizuS, SaitoH, KonoY, et al. The prognostic significance of the comprehensive complication index in patients with gastric cancer[J]. Surg Today,2019,49(11):913‑920. DOI: 10.1007/s00595-019-01828-3.
|
[23] |
RayS, MehtaNN, ManglaV, et al. A comparison between the comprehensive complication index and the Clavien-Dindo grading as a measure of postoperative outcome in patients undergoing gastrointestinal surgery-a prospective study[J]. J Surg Res,2019,244:417‑424. DOI: 10.1016/j.jss.2019.06.093.
|
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