Preoperative risk factors for major postoperative complications after complex gastrointestinal cancer surgery: A systematic review

Abstract

Patients undergoing complex gastrointestinal surgery are at high risk of major postoperative complications (e.g., anastomotic leakage, sepsis), classified as Clavien-Dindo (CD) ! IIIa. Identification of preoperative risk factors can lead to the identification of high-risk patients. These risk factors can also be used to design personalized perioperative care. This systematic review focuses on the identification of these factors. The Medline and Embase databases were searched for prospective, retrospective cohort studies and randomized controlled trials investigating the effect of risk factors on the occurrence of major postoperative complications and/or mortality after complex gastrointestinal cancer surgery. Risk of bias was assessed using the Quality in Prognostic Studies tool. The level of evidence was graded based on the number of studies reporting a significant association between risk factors and major complications. A total of 207 eligible studies were retrieved, identifying 33 risk factors for major postoperative complications and 13 preoperative laboratory results associated with postoperative complications. The present systematic review provides a comprehensive overview of preoperative risk factors associated with major postoperative complications. A wide range of risk factors are amenable to actions in perioperative care and prehabilitation programs, which may lead to improved outcomes for high-risk patients. Additionally, the knowledge of this study is important for benchmarking surgical outcomes.

Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life

“…As stated, the decision between an anastomosis and a (temporary) stoma after sphincter-sparing rectal cancer surgery is motivated by the risk of adverse events (e.g., anastomotic leakage) and the expected functional outcomes [12,33,45]. However, since this decision is usually not a straightforward one, caused by the lack of a clinically "best choice," considering the risks of poor functional outcome makes this decision preference-sensitive and therefore particularly relevant for shared decision-making [34,46,47].…”

The associations between lipid profiles and visceral obesity among gastrointestinal cancer patients: a cross-sectional study

“…VFA is also associated with the surgical outcomes of gastrointestinal cancer patients [25]. Patients with obesity have a higher incidence of surgical and medical complications, such as mortality, infection, sepsis, and acute kidney injury [25,26].…”

“…VFA is also associated with the surgical outcomes of gastrointestinal cancer patients [25]. Patients with obesity have a higher incidence of surgical and medical complications, such as mortality, infection, sepsis, and acute kidney injury [25,26]. Chen et al conducted a prospective study among 376 colorectal surgery subjects and discovered that age, excessive inner fat accumulation, and muscle attenuation were independent threats to postoperative complications [27].…”

“…In terms of gastrectomy, Yang et al considered that patients with VFA equal to or greater than 100 cm 2 encountered more intraoperative bleeding, prolonged operative time, and a higher occurrence rate of postoperative complications [28]. Increased abdominal fat tissue elevated the difficulties of gastrointestinal surgeries, since excessive visceral fat tissue may increase abdominal wall pressure, contribute to a normal anatomical field, and narrow the operative visibility, further resulting in a longer duration of operation and increased blood loss [25,28]. Obese patients undergoing rectal resections are also at risk of anastomotic leakage and carry at least 1.2 times the odds of wound infection due to technical and metabolic factors [29,30].…”

Risk factor analysis and construction of prediction models for short-term postoperative complications in patients undergoing gastrointestinal tract surgery

“…Meanwhile, postoperative complications represent the greatest obstacle that hinders recovery ( 4 ). When complications are treated inappropriately, they may lead to a rapid decline in the quality of life of the patient as well as an increase in medical expenses and mortality ( 5 , 6 ). Therefore, early detection of and intervention for complications can effectively reduce the duration of hospitalization and medical expenditure.…”