Skip to main content
SpringerLink
Log in

Predicting primary postoperative pulmonary complications in patients undergoing minimally invasive surgery for colorectal cancer

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Objective

To determine the risk factors for developing primary postoperative pulmonary complications (PPC) in patients undergoing minimally invasive colorectal surgery (MIS) for the treatment of cancer and to identify the potential indicators for more extensive preoperative evaluation.

Materials and methods

The ACS-NSQIP® database was interrogated to capture patients who had elective colon or rectal cancer and underwent MIS between 2012 and 2017. Patients who had primary PPC including pneumonia, unplanned intubation and/or failure to wean from mechanical ventilation for > 48 h were compared to patients without PPC. Significant risk factors for PPC were retained to build a predictive risk model through logistic regression analysis. The model was then internally validated using 2018 data.

Results

Of 50,150 patients identified, 637 (1.3%) had PPC. The final risk prediction model included six variables: history of chronic obstructive pulmonary disease, age, smoking status, functional health status, pre-operative congestive heart failure, and American Society of Anesthesiology class ≥ 3. The model achieved good calibration (Hosmer–Lemeshow goodness-of-fit test, p = 0.614) and discrimination (c statistics = 0.757). Internal validation achieved similar discrimination (c statistics = 0.798).

Conclusion

Primary postoperative pulmonary complications affected 1.3% of patients undergoing MIS for colon or rectal cancer. The novel predictive risk score showed good discrimination and may help to identify patients who may benefit from perioperative optimization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jurt J, Hubner M, Pache B, Hahnloser D, Demartines N, Grass F (2018) Respiratory complications after colorectal surgery: avoidable or fate? World J Surg 42(9):2708–2714. https://doi.org/10.1007/s00268-018-4699-2

    Article  PubMed  Google Scholar 

  2. Miskovic A, Lumb AB (2017) Postoperative pulmonary complications. Br J Anaesth 118(3):317–334. https://doi.org/10.1093/bja/aex002

    Article  CAS  Google Scholar 

  3. Haines KJ, Skinner EH, Berney S (2013) Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy 99(2):119–125. https://doi.org/10.1016/j.physio.2012.05.013

    Article  CAS  PubMed  Google Scholar 

  4. Zogg CK, Najjar P, Diaz AJ, Zogg DL, Tsai TC, Rose JA Jr, Scott JW, Gani F, Alshaikh H, Canner JK, Schneider EB, Goldberg JE, Haider AH (2016) Rethinking priorities: cost of complications after elective colectomy. Ann Surg 264(2):312–322. https://doi.org/10.1097/sla.0000000000001511

    Article  PubMed  Google Scholar 

  5. Rauh R, Hemmerling TM, Rist M, Jacobi KE (2001) Influence of pneumoperitoneum and patient positioning on respiratory system compliance. J Clin Anesth 13(5):361–365. https://doi.org/10.1016/s0952-8180(01)00286-0

    Article  CAS  PubMed  Google Scholar 

  6. O'Malley C, Cunningham AJ (2001) Physiologic changes during laparoscopy. Anesthesiol Clin N Am 19(1):1–19. https://doi.org/10.1016/s0889-8537(05)70208-x

    Article  CAS  Google Scholar 

  7. Milone M, Elmore U, Vignali A, Mellano A, Gennarelli N, Manigrasso M, Milone F, De Palma GD, Muratore A, Rosati R (2017) Pulmonary complications after surgery for rectal cancer in elderly patients: evaluation of laparoscopic versus open approach from a multicenter study on 477 consecutive cases. Gastroenterol Res Pract 2017:5893890. https://doi.org/10.1155/2017/5893890

    Article  PubMed  PubMed Central  Google Scholar 

  8. Li Y, Wang S, Gao S, Yang C, Yang W, Guo S (2016) Laparoscopic colorectal resection versus open colorectal resection in octogenarians: a systematic review and meta-analysis of safety and efficacy. Tech Coloproctol 20(3):153–162. https://doi.org/10.1007/s10151-015-1419-x

    Article  CAS  PubMed  Google Scholar 

  9. Abd El Aziz MA, Grass F, Behm KT, Shawki S, D'Angelo AL, Mathis KL, Larson DW (2020) Trends of complications and innovative techniques' utilization for colectomies in the United States. Updates Surg. https://doi.org/10.1007/s13304-020-00862-y

    Article  PubMed  Google Scholar 

  10. Abd El Aziz MA, Grass F, Perry W, Behm KT, Shawki SF, Larson DW, Mathis KL (2020) Colectomy for patients with super obesity: current practice and surgical morbidity in the United States. Surg Obes Relat Dis. https://doi.org/10.1016/j.soard.2020.06.033

    Article  PubMed  Google Scholar 

  11. Sujatha-Bhaskar S, Alizadeh RF, Inaba CS, Koh CY, Jafari MD, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A (2018) Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surg Endosc 32(3):1280–1285. https://doi.org/10.1007/s00464-017-5805-5

    Article  PubMed  Google Scholar 

  12. Antoniou SA, Antoniou GA, Koch OO, Kohler G, Pointner R, Granderath FA (2015) Laparoscopic versus open obesity surgery: a meta-analysis of pulmonary complications. Dig Surg 32(2):98–107. https://doi.org/10.1159/000371749

    Article  PubMed  Google Scholar 

  13. Lee CZ, Kao LT, Lin HC, Wei PL (2015) Comparison of clinical outcome between laparoscopic and open right hemicolectomy: a nationwide study. World J Surg Oncol 13:250. https://doi.org/10.1186/s12957-015-0666-7

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bablekos GD, Michaelides SA, Analitis A, Charalabopoulos KA (2014) Effects of laparoscopic cholecystectomy on lung function: a systematic review. World J Gastroenterol 20(46):17603–17617. https://doi.org/10.3748/wjg.v20.i46.17603

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jiang L, Yang KH, Guan QL, Cao N, Chen Y, Zhao P, Chen YL, Yao L (2013) Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc 27(7):2466–2480. https://doi.org/10.1007/s00464-012-2758-6

    Article  Google Scholar 

  16. Schiphorst AH, Verweij NM, Pronk A, Borel Rinkes IH, Hamaker ME (2015) Non-surgical complications after laparoscopic and open surgery for colorectal cancer—a systematic review of randomised controlled trials. Eur J Surg Oncol 41(9):1118–1127. https://doi.org/10.1016/j.ejso.2015.04.007

    Article  CAS  PubMed  Google Scholar 

  17. Hall JC, Tarala RA, Hall JL, Mander J (1991) A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 99(4):923–927. https://doi.org/10.1378/chest.99.4.923

    Article  CAS  PubMed  Google Scholar 

  18. Kapoor A, Nassir A, Chew B, Gillis A, Luke P, Whelan P (2004) Comparison of laparoscopic radical renal surgery in morbidly obese and non-obese patients. J Endourol 18(7):657–660. https://doi.org/10.1089/end.2004.18.657

    Article  PubMed  Google Scholar 

  19. Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, Wichman TO, Morrow LE (2013) Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc 88(11):1241–1249. https://doi.org/10.1016/j.mayocp.2013.06.027

    Article  PubMed  Google Scholar 

  20. Arozullah AM, Daley J, Henderson WG, Khuri SF (2000) Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg 232(2):242–253. https://doi.org/10.1097/00000658-200008000-00015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Gupta H, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, Morrow LE (2011) Development and validation of a risk calculator predicting postoperative respiratory failure. Chest 140(5):1207–1215. https://doi.org/10.1378/chest.11-0466

    Article  PubMed  Google Scholar 

  22. Canet J, Sabate S, Mazo V, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P (2015) Development and validation of a score to predict postoperative respiratory failure in a multicentre European cohort: a prospective, observational study. Eur J Anaesthesiol 32(7):458–470. https://doi.org/10.1097/eja.0000000000000223

    Article  PubMed  Google Scholar 

  23. Hua M, Brady JE, Li G (2012) A scoring system to predict unplanned intubation in patients having undergone major surgical procedures. Anesth Analg 115(1):88–94. https://doi.org/10.1213/ANE.0b013e318257012b

    Article  PubMed  PubMed Central  Google Scholar 

  24. Blum JM, Stentz MJ, Dechert R, Jewell E, Engoren M, Rosenberg AL, Park PK (2013) Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population. Anesthesiology 118(1):19–29. https://doi.org/10.1097/ALN.0b013e3182794975

    Article  PubMed  Google Scholar 

  25. Kor DJ, Warner DO, Alsara A, Fernandez-Perez ER, Malinchoc M, Kashyap R, Li G, Gajic O (2011) Derivation and diagnostic accuracy of the surgical lung injury prediction model. Anesthesiology 115(1):117–128. https://doi.org/10.1097/ALN.0b013e31821b5839

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jeong BH, Shin B, Eom JS, Yoo H, Song W, Han S, Lee KJ, Jeon K, Um SW, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Woo S, Park HY (2014) Development of a prediction rule for estimating postoperative pulmonary complications. PLoS ONE 9(12):e113656. https://doi.org/10.1371/journal.pone.0113656

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Wong DH, Weber EC, Schell MJ, Wong AB, Anderson CT, Barker SJ (1995) Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 80(2):276–284. https://doi.org/10.1097/00000539-199502000-00013

    Article  CAS  PubMed  Google Scholar 

  28. Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, Sabate S, Mazo V, Briones Z, Sanchis J (2010) Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 113(6):1338–1350. https://doi.org/10.1097/ALN.0b013e3181fc6e0a

    Article  PubMed  Google Scholar 

  29. Mazo V, Sabate S, Canet J, Gallart L, de Abreu MG, Belda J, Langeron O, Hoeft A, Pelosi P (2014) Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology 121(2):219–231. https://doi.org/10.1097/aln.0000000000000334

    Article  PubMed  Google Scholar 

  30. Bare M, Monton C, Mora L, Redondo M, Pont M, Escobar A, Sarasqueta C, Fernandez de Larrea N, Briones E, Quintana JM (2017) COPD is a clear risk factor for increased use of resources and adverse outcomes in patients undergoing intervention for colorectal cancer: a nationwide study in Spain. Int J Chronic Obstr Pulmon Dis 12:1233–1241. https://doi.org/10.2147/copd.S130377

    Article  Google Scholar 

  31. Greco M, Capretti G, Beretta L, Gemma M, Pecorelli N, Braga M (2014) Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials. World J Surg 38(6):1531–1541. https://doi.org/10.1007/s00268-013-2416-8

    Article  PubMed  Google Scholar 

  32. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O (2013) Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS((R))) Society recommendations. World J Surg 37(2):259–284. https://doi.org/10.1007/s00268-012-1772-0

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research did not receive any funding.

Author information

Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 First St. Southwest, Rochester, MN, 55905, USA

    Mohamed A. Abd El Aziz, William R. Perry, Fabian Grass, Kellie L. Mathis, David W. Larson & Kevin T. Behm

  2. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    Jay Mandrekar

Authors
  1. Mohamed A. Abd El Aziz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William R. Perry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabian Grass
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kellie L. Mathis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David W. Larson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jay Mandrekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kevin T. Behm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin T. Behm.

Ethics declarations

Conflict of interest

The authors have no conflict of interst.

Ethical approval

Institutional Review Board approval was not required for this study.

Research involving human participants and/or animals

This article does not contain any experimental studies with human participants or animals performed by any of the authors.

Informed consent

For this study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abd El Aziz, M.A., Perry, W.R., Grass, F. et al. Predicting primary postoperative pulmonary complications in patients undergoing minimally invasive surgery for colorectal cancer. Updates Surg 72, 977–983 (2020). https://doi.org/10.1007/s13304-020-00892-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00892-6

Keywords

Search

Navigation