title: Risk factors for early complications after laparoscopic total mesorectal excision for locally advanced rectal cancer: A single center experience.
abstract: BACKGROUND
  Laparoscopic total mesorectal excision (TME) for rectal cancer has become a widely used surgical strategy in the treatment of rectal cancer. Laparoscopic rectal cancer surgery aims to provide patients with curative resection as well as minimize postoperative morbidity. This study was designed to analyze the foreseeable risk factors linked to postoperative morbidity in patients undergoing laparoscopic total mesorectal excision.
  
  
  METHODS
  From February 2008 to May 2010, 306 consecutive patients underwent laparoscopic TME. Postoperative complications including wound infection, pneumonia, urethritis were recorded. Eleven potential risk factors for postoperative complications were analyzed.
  
  
  RESULTS
  The overall postoperative complication rate was 22.3%, and the complications included wound infection (5.2%), pneumonia (4.5%), urethritis (3.9%), anastmosis bleed (1.9%), anastmosis leakage (3.2%), and obstruction (3.6%). The risk factors responsible for the complications were conversion (P = 0.002); operation time > 210 min (P = 0.047); age > 70 yr (P = 0.026); tumor size >4 cm (P = 0.005); preoperative chemoradiotherapy (P = 0.017); and a lower tumor location (P = 0.048). Conversion was positively related to wound infection and obstruction. Tumor size >4 cm and preoperative chemoradiotherapy were high-risk factors for urethritis. Operating time >210 min and age >70 year were associated with postoperative pneumonia. Lower tumor and age >70 yr were significant risk factors for anastmosis leakage.
  
  
  CONCLUSIONS
  Aged patients, large tumor, lower tumor location and conversion were risk factors in performing laparoscopic TME for locally advanced rectal cancer. Patients with these characteristics should be carefully considered before undergoing laparoscopic total mesorectal excision.
authors.forename: Liye
authors.initials: L
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.forename: Guohu
authors.initials: G
authors.lastname: Zhang
authors.forename: Ruiwu
authors.initials: R
authors.lastname: Dai
authors.forename: Hongyin
authors.initials: H
authors.lastname: Liang
authors.affiliation: Department of General Surgery, Chengdu Military General Hospital, Chengdu, People's Republic of China.
authors.forename: Lijun
authors.initials: L
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D059248:Chemoradiotherapy; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome