Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press49210.17650/2686-9594-2021-11-1-21-27ORIGINAL REPORTОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕAssessing the risk of postoperative mortality in patients undergoing emergency surgery for complicated colorectal cancerОценка риска послеоперационной летальности при экстренной хирургии осложненного колоректального ракаhttps://orcid.org/0000-0002-1832-5255ShchaevaS.   N.ЩаеваС. Н.
Russian Federation

Svetlana Nikolaevna Shchaeva 

28 Krupskoy St., Smolensk 214019

Светлана Николаевна Щаева  

214019 Смоленск, ул. Крупской, 28

shaeva30@mail.ruMagidovL.  A. МагидовЛ. А.
Russian Federation

40 Frunze St., Smolensk 214006

214006 Смоленск, ул. Фрунзе, 40

Smolensk State Medical University, Ministry of Health of RussiaФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава РоссииClinical Hospital No. 1ОГБУЗ «Клиническая больница № 1»0206202111121270106202101062021Copyright ©; 2021, Shchaeva S.N., Magidov L.A.Copyright ©; 2021, Щаева С.Н., Магидов Л.А.2021Shchaeva S.N., Magidov L.A.Щаева С.Н., Магидов Л.А.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/492

Objective: to analyze factors affecting the mortality of patients who have undergone emergency surgeries for complicated colorectal cancer.Materials and methods. In this retrospective study, we evaluated treatment outcomes of 112 patients who underwent surgeries for complicated colorectal cancer in 3 clinical hospitals of Smolensk between 2014 and 2019. We included patients with moderate or severe disease (ASA II or III) who have undergone emergency resections for intestinal obstruction or tumor perforation. We assessed clinical, laboratory, and tumor‑associated factors affecting postoperative mortality.Results. Patients’ gender had no significant impact on postoperative mortality (p = 0.69). Mean age of study participants was 65 years (range: 43–86 years). Age also did not affect postoperative mortality; most of the patients both among those died (n = 19) and survived (n = 93) were older than 60 years (p = 0.46). We observed no significant correlation between tumor location and postoperative mortality (p = 0.27). Of 19 patients with lethal outcomes, five died due to pulmonary embolism. They have elevated level of D‑dimer, which was significantly higher than that in survivors (p = 0.014). The lowest mortality was observed in patients who have undergone two‑stage surgeries with tumor removed at the second stage compared to patients operated on using other techniques (p = 0.041). Using multivariate logistic regression, we identified independent factors that affected mortality. They included: tumor perforation (odds ratio (OR) 2.8; 95 % confidence interval (CI) 1.2–7.6; p = 0.003), severe comorbidity (OR 1.6; 95 % CI 1.7–8.2; p = 0.02), D‑dimer level >510.1 ± 10.2 ng/L (OR 1.5; 95 % CI 1.3–4.5; p = 0.01), type of surgery, namely resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage (OR 1.2; 95 % CI 1.1–6.3; p = 0.04).Conclusions. Tumor perforation, cardiovascular disease in combination with other comorbidities, type of surgery (resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage), and elevated preoperative level of D‑dimer had the most significant impact on postoperative mortality.

Цель исследования – изучение факторов, влияющих на летальность пациентов, перенесших экстренные хирургические вмешательства по поводу осложненного колоректального рака.Материалы и методы. Ретроспективно изучены результаты лечения 112 пациентов, перенесших экстренные хирургические вмешательства по поводу осложненного колоректального рака в 3 клинических больницах г. Смоленска за период 2014–2019 гг. В исследование включены больные, перенесшие экстренные резекционные вмешательства по поводу кишечной непроходимости или перфорации опухоли, состояние которых оценивалось как среднетяжелое или тяжелое, соответствующие ASA II, III. Изучены клинические, лабораторные и туморассоциированные факторы, влияющие на послеоперационную летальность.Результаты. Пол не оказывал статистически значимого влияния на послеоперационную летальность (p = 0,69). Средний возраст пациентов всей исследуемой когорты составил 65 (43–86) лет. Возраст не оказывал статистически значимого влияния на послеоперационную летальность, так как и среди умерших пациентов (n = 19), и среди выживших (n = 93) преобладали лица старше 60 лет (p = 0,46). Локализация опухоли не оказала статистически значимого влияния на послеоперационную летальность (p = 0,27). Из 19 больных с летальным исходом у 5 причиной смерти стала тромбоэмболия легочной артерии, у данных пациентов наблюдалось повышение уровня D‑димера, различия с выжившими имеют статистически значимый характер (p = 0,014). Наименьшая летальность наблюдалась после перенесенных двухэтапных оперативных вмешательств с удалением опухоли на 2‑м этапе по сравнению с другими видами операций (p = 0,041). С использованием многофакторной логистической регрессии установлены факторы с независимым влиянием на риск летального исхода: перфорация опухоли (отношение шансов (ОШ) 2,8; 95 % доверительный интервал (ДИ) 1,2–7,6; р = 0,003), тяжелая степень коморбидности (ОШ 1,6; 95 % ДИ 1,7–8,2; р = 0,02), уровень D‑димера выше 510,1 ± 10,2 нг/л (ОШ 1,5; 95 % ДИ 1,3–4,5; р = 0,01), тип выполненной операции – резекционные вмешательства с формированием первичного анастомоза и двухэтапные оперативные вмешательства с удалением опухоли на 1‑м этапе (ОШ 1,2; 95 % ДИ 1,1–6,3; р = 0,04).Выводы. На уровень послеоперационной летальности наибольшее влияние оказывали перфорация опухоли, наличие заболеваний сердечно‑сосудистой системы в сочетании с заболеваниями других систем, повышенный уровень D‑димера в предоперационном периоде, выполнение резекционных вмешательств с формированием первичного анастомоза и двухэтапных оперативных вмешательств с удалением опухоли на 1‑м этапе.

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