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Acta Oncologica Turcica 2022; 55: 165-173171In this study to rate complications aftersurgery for colorectal malignancy, the cut-offvalue for age was 65. In our study, the degreeof complications was observed to increasewith increasing age. However, there was nostatistically significant difference between thedegree of complication and age.Another factor in terms of complications isobesity. Obesity not only makes the proceduremore technically demanding and potentiallylonger, but also increases the risk ofdeveloping wound infection. Recent studieshave examined the relationship betweenobesity and surgical site infection after colorectalsurgery. These studies reported thatpatients with a BMI above 30 kg/m 2 had anincreased surgical site infection [8]. There arealso publications reporting that BMI is anindependent risk factor for anastomoticleakage [9]. In the present study, thecomplication degree of BMI was compared,but no statistically significant result wasdetermined.One of the factors affecting both the surgeryto be performed on the patient and the postoperativefollow-up is the existing comorbiditiesof the patient. Due to comorbidities,the wound healing of the patientchanges significantly and the severity of thecomplication may increase accordingly. Poorglycemic control caused an increase in theincidence of surgical site infections in theearly postoperative period in patientsundergoing colorectal surgery [10]. In ourstudy, both classification systems wereexamined and it was observed that diabetesconstitutes approximately twice the risk ofdeveloping complications in diabetesmellitus, according to the Clavien-Dindoclassification. No statistically significant riskfor diabetes mellitus was found in the CTCAEclassification.In the literature, it has been reported thatanastomotic leakage that develops aftercolorectal surgery is more common in men. Itwww.actaoncologicaturcica.comwas thought that this might occur as a result oftechnical difficulties in male patients due totheir narrow pelvis [11]. Studies examiningthe patient group undergoing LAR haveobserved that male gender is a risk factor forthe development of anastomotic leakage [12].According to the Clavien-Dindo classification,three times more complications wereobserved in the male gender, but this inferencewas not detected in the CTCAE classification.15-20% of colorectal cancer patients haveliver metastases at the time of initialdiagnosis. In 70-80% of this patient group,metastasis is limited to the liver only [13-15].However, some authors stated that simultaneousresection reduces the tumor burden,reduces the economic and psychologicalburden of patients, and allows patients toundergo a single surgical procedure instead oftwo [16]. A growing number of authors arguethat the optimal operative timing changesgradually from gradual resection to simultaneousresection. In our study, the risk ofcomplications was found to be five timeshigher in the group with simultaneous liverresection compared to the CTCAE classification.This was not found to be significantin the Clavien Dindo class-ification.The use of laparoscopy in surgery for colorectalmalignancy is extremely common.Compared to open surgery, laparoscopicsurgery has advantages such as smallerincision length, less blood loss and less pain.However, previous studies have shown thatlaparoscopic surgery has some limitations,such as longer operative time and longerlearning curve for surgeons [17, 18]. Laparoscopicsurgery is less effective for largertumors due to traction limitation andconsequent insufficient exploration [19]. Theincidence of postoperative complications wassignificantly reduced in the laparoscopicsurgery group compared to the open surgerygroup [20,21]. In our study, open surgery wasdetermined as a risk factor for theCopyright©Ankara Onkoloji Hastanesi
Acta Oncologica Turcica 2022; 55: 165-173172development of complications in the technique.While some factors that affect thecomplications that develop after surgery arepatient-dependent and cannot be changed,there are also risk factors that can be changeddepending on the choice of surgical technique.Laparoscopic surgery performed by experiencedcolorectal surgeons reduces the postsurgicalcomplication rate.ConclusionThe present study evaluated complications ofcolorectal cancer surgery in terms of Clavien-Dindo and CTCAE classifications. It wasdetermined according to both classificationsystems that as the degree of complicationincreases, the length of hospital stay alsoincreases. According to both classificationsystems, open surgery was found to be a riskfactor for the development of complicationscompared to laparoscopic surgery. Accordingto the Clavien-Dindo classification, malegender and diabetes mellitus are other riskfactors for the development of complications.According to the CTCAE classification,performing liver resection in addition to opensurgery increases the risk of complications.The two classifications have both similaritiesand differences in revealing the risk factorsthat cause postoperative complications. Thereis no superiority between the two classificationsystems when grading postoperativecomplications, and both systems can be usedto rate surgical complications.REFERENCES1. Corman ML, Allison SI, Kuehne JP. Handbookof Colon and Rectal Surgery. Lippincott Williams &Wilkins; 2002.2. Dindo D, Demartines N, Clavien P-A.Classification of Surgical Complications. Annals ofSurgery. 2004; 240(2): 205-213.3. US Department of Health and HumanServices. (2019). Common Terminology Criteria forAdverse Events (CTCAE) version 5.0. PublishedNovember27, 2017.Url: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdfAccessed:04.02.20194. Clavien PA, Sanabria JR, Strasberg SM.Proposed classification of complications of surgerywith examples of utility in cholecystectomy. Surgery.1992; 111(5): 518-526.5. Health UDo, Services H. Common terminologycriteria for adverse events (CTCAE), version 4.0. 2009.National Institute of Health, National Cancer Institute.2017; 4(03).6. Zawadzki M, Krzystek-Korpacka M, Rząca M,Czarnecki R, Obuszko Z, Sitarska M, et al. Risk factors inreoperations in colorectal surgery. Pol Przegl Chir.2019; 91(4): 13-8.7. Jafari MD, Jafari F, Halabi WJ, et al. ColorectalCancer Resections in the Aging US Population: A TrendToward Decreasing Rates and Improved Outcomes.JAMA surgery. 2014; 149(6): 557-564.8. Itani KMF, Jensen EH, Finn TS, Tomassini JE,Abramson MA. Effect of Body Mass Index andErtapenem versus Cefotetan Prophylaxis on SurgicalSite Infection in Elective Colorectal Surgery. SurgicalInfections. 2008; 9(2): 131-137.9. Yamamoto S, Fujita S, Akasu T, Inada R, MoriyaY, Yamamoto S. Risk Factors for Anastomotic LeakageAfter Laparoscopic Surgery for Rectal Cancer Using aStapling Technique. Surgical Laparoscopy, Endoscopy &Percutaneous Techniques. 2012; 22(3): 239-243.10. Sehgal R, Berg A, Figueroa R, et al. Risk Factorsfor Surgical Site Infections after Colorectal Resection inDiabetic Patients. Journal of the American College ofSurgeons. 2011; 212(1): 29-34.11. Park JS, Choi G-S, Kim SH, et al. MulticenterAnalysis of Risk Factors for Anastomotic Leakage AfterLaparoscopic Rectal Cancer Excision. Annals of Surgery.2013; 257(4): 665-671.12. Kim SH, Park IJ, Joh YG, Hahn KY. LaparoscopicResection of Rectal Cancer: A Comparison of Surgicaland Oncologic Outcomes Between Extraperitoneal andIntraperitoneal Disease Locations. Diseases of theColon & Rectum. 2008; 51(6): 844-851.www.actaoncologicaturcica.comCopyright©Ankara Onkoloji Hastanesi
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