Systematic assessment of complications after laparoscopic colorectal surgery for advanced colorectal cancer: A retrospective study using Clavien–Dindo classification, 5-year experience

Mahmut Said Degerli¹, Alp Omer Canturk¹, Hilmi Bozkurt², Orcun Alpay¹, Muzaffer Akinci¹, Yusuf Emre Altundal³, Turgay Yildiz⁴, Dogan Yildirim¹

1. Department of General Surgery, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
2. Department of Gastrointestinal Surgery, University of Health Sciences, Haseki Training and Research Hospital, Istanbul, Turkey
3. Department of General Surgery, T.R. Ministry of Health Istanbul Arnavutkoy State Hospital, Istanbul, Turkey
4. Department of General Surgery, Avrasya Hospital Gaziosmanpasa, Istanbul, Turkey

*Corresponding Author: Mahmut Said Degerli, Email; drmsdegerli@gmail.com

Abstract

Aim

The presence and frequency of surgical complications indicate the quality of the surgery performed. However, a standard classification system should specify, describe, and compare complications. Clavien Dindo classification is an easily applicable classification in the evaluation of complications. Our study aimed to reveal the severity of complications and the factors affecting them by using the Clavien Dindo classification in patients undergoing laparoscopic colorectal surgery.

Methods

Between January 2015 and December 2020, we retrospectively collected the laparoscopic colorectal surgery complications using Clavien Dindo grading in patients in our colorectal surgery unit in the database. The outcome variables studied were age, gender, BMI, ASA score, postoperative length of hospital stay, operation procedure, cancer size, postoperative mortality.

Results

There were 53 males and 17 female patients, with a mean age of 56,9±13,4.(19-81). Seventy patients, 32 (45%), had at least one postoperative complication. About complications; 58.6% were rated as Clavien I, 22.9% as Clavien II, 8.6% as Clavien IIIa, 4.3% as Clavien IIIb, 2.9% as Clavien IVa, and 2.9% as Clavien V. There was no Clavien grade IVb complication in any of the patients. Length of hospital stays was significantly higher in patients with had major complex surgery and had higher scores. Clavien Dindo classification was positively statistically significantly related to the day of hospitalization in male and female sex (p<0.001 for all). In addition, positively significantly related to Clavien Dindo classation and tumor diameter in the female sex (p=0.014) detected.

Conclusions

In laparoscopic colorectal surgery, the Clavien-Dindo classification can be easily applied and used safely to determine complication rates. The reason for this statistical difference that we detected in our study and that occurs in women may be due to anatomical differences or the surgeon’s experience.

Keywords: Postoperative complications, Clavien–Dindo classification, Colorectal Cancer, Laparoscopic Colorectal Surgery