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Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar

Year 2023, Issue: 21 - December, 903 - 919, 05.01.2024
https://doi.org/10.38079/igusabder.1173461

Abstract

Amaç: Bu araştırma ile kolorektal kanser cerrahisi geçiren hastalarda görülen postoperatif komplikasyonlar incelenmiştir.
Yöntem: Kesitsel bir araştırma olarak yürütülen çalışmaya kolorektal kanser cerrahisi geçiren 127 hasta dahil edilmiştir. Postoperatif 30 gün boyunca komplikasyon açısından takip edilen hastalarda görülen komplikasyonlar Clavien-Dindo sınıflandırma sistemi kullanılarak kaydedilmiştir.
Bulgular: Clavien-Dindo sınıflandırma sistemine göre hastaların %44,9’unda I. derece, %42,5 inde II. derece, %8,6’sında III. derece, %2,4’ünde IV. Derece ve %1,6’sında V. derece komplikasyon geliştiği tespit edilmiştir. Çalışmada kolorektal kanser cerrahisi geçiren hastaların 30 günlük majör postoperatif komplikasyon oranı %12,6; mortalite oranı %1,6’dır. Daha önce bağırsak cerrahisi geçirme durumu, cerrahi işlem süresi, postoperatif hastanede kalış süresi ve komplikasyon dereceleri arasında anlamlı bir ilişki olduğu belirlenmiştir.
Sonuç: Kolorektal kanser cerrahisi geçiren hastaların postoperatif komplikasyon riskleri açısından değerlendirmesi, mevcut risklere karşı önlemler alınması ve postoperatif komplikasyonların uygun şekilde yönetimi ve takibi sağlanmalıdır.

References

  • 1. American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. Centers for Disease Control and Prevention. 2017.
  • 2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Vol. 71, CA: A Cancer Journal for Clinicians. 2021. p. 209–49.
  • 3. Healthcare Quality Improvement Partnership. National Bowel Cancer Audit Annual Report [Internet]. 2020. Available from: https://www.nboca.org.uk/content/uploads/2020/01/NBOCA-2019-V2.0.pdf
  • 4. Tevis SE, Kennedy GD. Postoperative Complications: Looking Forward to a Safer Future. Clin Colon Rectal Surg. 2016;29(3):246–52.
  • 5. Aoyama T, Oba K, Honda M, Sadahiro S, Hamada C, Mayanagi S, et al. Impact of postoperative complications on the colorectal cancer survival and recurrence: analyses of pooled individual patients’ data from three large phase III randomized trials. Vol. 6, Cancer Medicine. 2017. p. 1573–80.
  • 6. Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: Results of a prospective multicenter study. Arch Surg [Internet]. 2005 Mar [cited 2020 Feb 13];140(3):278–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15781793
  • 7. Fagard K, Casaer J, Wolthuis A, Flamaing J, Milisen K, Lobelle JP, et al. Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer. Color Dis. 2017;19(9):O329–38.
  • 8. Huang Z-X, Zhou Z, Shi H-R, Li T-Y, Ye S-P. Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center. World J Gastrointest Surg. 2021;13(12):1660–72.
  • 9. Loogman L, de Nes LCF, Heil TC, Kok DEG, Winkels RM, Kampman E, et al. The Association Between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients With Colorectal Cancer. Dis Colon Rectum. 2021;64(11):1342–53.
  • 10. Park EJ, Baik SH, Kang J, Hur H, Min BS, Lee KY, et al. The Impact of Postoperative Complications on Long-term Oncologic Outcomes after Laparoscopic Low Anterior Resection for Rectal Cancer. Med (United States). 2016;95(14):1–9.
  • 11. Tevis SE, Kennedy GD. Postoperative complications and implications on patient-centered outcomes. Vol. 181, Journal of Surgical Research. 2013. p. 106–13.
  • 12. Couwenberg AM, de Beer FSA, Intven MPW, Burbach JPM, Smits AB, Consten ECJ, et al. The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study. J Geriatr Oncol [Internet]. 2018;9(2):102–9. Available from: https://doi.org/10.1016/j.jgo.2017.09.005
  • 13. Pinto A, Faiz O, Davis R, Almoudaris A, Vincent C. Surgical complications and their impact on patients’psychosocial well-being:a systematic review and meta-analysis. BMJ Open. 2016;6.
  • 14. Breugom AJ, van Dongen DT, Bastiaannet E, Dekker FW, van der Geest LGM, Liefers GJ, et al. Association Between the Most Frequent Complications After Surgery for Stage I–III Colon Cancer and Short-Term Survival, Long-Term Survival, and Recurrences. Ann Surg Oncol. 2016;23(9):2858–65.
  • 15. McSorley ST, Horgan PG, McMillan DC. The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2016;97:168–77.
  • 16. Tohme S, Simmons RL, Tsung A. HHS Public Access (102). Surg Cancer A Trigger Metastases Samer. 2018;77(7):1548–52.
  • 17. Lindholm S, Academy TS, Gamage DB. The Clavien-Dindo Classification a useful tool in measuring postoperative complications following colorectal cancer surgery at Colombo South Teaching Hospital Degree Project in Medicine. 2020; 18. Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250(2):187–96.
  • 19. Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: Risk factors and preventive strategies [Internet]. Vol. 4, Patient Safety in Surgery. 2010 [cited 2020 Feb 13]. p. 5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20338045
  • 20. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis [Internet]. 1987 [cited 2021 Jun 26];40(5):373–83. Available from: https://pubmed.ncbi.nlm.nih.gov/3558716/
  • 21. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992 Dec;111(5):518–26.
  • 22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
  • 23. Sheng S, Tiancheng Z, Wang X. Comparison of robot-assisted surgery,laparoscopic-assisted surgery, and open surgeryfor the treatment of colorectal cancer. Medicine (Baltimore). 2018;97(34):e11817.
  • 24. Ng KT, Tsia AK V, Chong VYL. Robotic Versus Conventional Laparoscopic Surgeryfor Colorectal Cancer: A Systematic Review and Meta-Analysiswith Trial Sequential Analysis. World J Surg. 2019;43:1146–61.
  • 25. Cengiz H, Aygin D. Validity and reliability study of the Turkish version of the postoperative recovery index of patients undergoing surgical intervention. Turkish J Med Sci. 2019;49(2):566–73.
  • 26. Yolcu S, Akın S. Ortopedi , Kalp ve Genel Cerrahi Ameliyatları Sonrası Dönemde Hastaların İyileşme Durumları ve Bakım Gereksinimlerinin Değerlendirilmesi. Sağlık ve Toplum. 2015;25(3):33–45.
  • 27. Zhang J, Du Z, Bi J, Wu Z, Lv Y, Zhang X, et al. The impact of previous abdominal surgery on clinical characteristics and prognosis of pyogenic liver abscess: A 10-year retrospective study of 392 patients. Med (United States). 2018;97(39):2–7. 28. Seetahal S, Obirieze A, Cornwell EE, Fullum T, Tran D. Open abdominal surgery: A risk factor for future laparoscopic surgery? Am J Surg [Internet]. 2015;209(4):623–6. Available from: http://dx.doi.org/10.1016/j.amjsurg.2014.12.017
  • 29. Husain F, Jeong IH, Spight D, Wolfe B, Mattar SG. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res. 2018;95(2):94–9.
  • 30. Procter LD, Davenport DL, Bernard AC, Zwischenberger JB. General Surgical Operative Duration Is Associated with Increased Risk-Adjusted Infectious Complication Rates and Length of Hospital Stay. J Am Coll Surg [Internet]. 2010;210(1):60-65.e2. Available from: http://dx.doi.org/10.1016/j.jamcollsurg.2009.09.034
  • 31. Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad PhD B, Ferko NC, Cameron CG, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res [Internet]. 2018;229:134–44. Available from: https://doi.org/10.1016/j.jss.2018.03.022
  • 32. Harrison OJ, Smart NJ, White P, Brigic A, Carlisle ER, Allison AS, et al. Operative Time and Outcome of Enhanced RecoveryAfter Surgery After Laparoscopic Colorectal Surgery. J Soc Laparoendosc Surg. 2014;18:265–72.
  • 33. Lobato LF de C, Ferreira PCA, Wick EC, Kiran RP, Remzi FH, Kalady MF, et al. Risk factors for prolonged length of stay after colorectal surgery. J Coloproctology. 2013;33(1):22–7.
  • 34. Ahmed Ali U, Dunne T, Gurland B, Vogel JD, Kiran RP. Actual versus estimated length of stay after colorectal surgery: Which factors influence a deviation? Am J Surg [Internet]. 2014;208(4):663–9. Available from: http://dx.doi.org/10.1016/j.amjsurg.2013.06.004
  • 35. Huebner M, Hübner M, Cima RR, Larson DW. Timing of complications and length of stay after rectal cancer surgery. J Am Coll Surg. 2014;218(5):914–9.

Postoperative Complications According to Clavien-Dindo Classification System in Patients Undergoing Colorectal Cancer Surgery

Year 2023, Issue: 21 - December, 903 - 919, 05.01.2024
https://doi.org/10.38079/igusabder.1173461

Abstract

Aim: In this study, postoperative complications observed in patients undergoing colorectal cancer surgery were investigated.
Method: 127 patients who underwent colorectal cancer surgery were included in the study, which was conducted as a cross-sectional study. Complications observed in patients who were followed up for complications for 30 days postoperatively were recorded using the Clavien-Dindo classification system.
Results: According to the Clavien-Dindo classification system, 44.9% of the patients were grade I and 42.5% were grade II. grade, III in 8.6%. grade, IV in 2.4%. Grade V complications were detected in 1.6% of them. In the study, the 30-day major postoperative complication rate of the patients who underwent colorectal cancer surgery was 12.6% and the mortality rate was 1.6%. It has been determined that there is a significant relationship between previous bowel surgery, duration of surgical procedure, postoperative hospital stay, and degree of complications.
Conclusion: Patients undergoing colorectal cancer surgery should be evaluated in terms of postoperative complication risks, measures should be taken against existing risks, and appropriate management and follow-up of postoperative complications should be provided.

References

  • 1. American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. Centers for Disease Control and Prevention. 2017.
  • 2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Vol. 71, CA: A Cancer Journal for Clinicians. 2021. p. 209–49.
  • 3. Healthcare Quality Improvement Partnership. National Bowel Cancer Audit Annual Report [Internet]. 2020. Available from: https://www.nboca.org.uk/content/uploads/2020/01/NBOCA-2019-V2.0.pdf
  • 4. Tevis SE, Kennedy GD. Postoperative Complications: Looking Forward to a Safer Future. Clin Colon Rectal Surg. 2016;29(3):246–52.
  • 5. Aoyama T, Oba K, Honda M, Sadahiro S, Hamada C, Mayanagi S, et al. Impact of postoperative complications on the colorectal cancer survival and recurrence: analyses of pooled individual patients’ data from three large phase III randomized trials. Vol. 6, Cancer Medicine. 2017. p. 1573–80.
  • 6. Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K. Postoperative mortality and morbidity in French patients undergoing colorectal surgery: Results of a prospective multicenter study. Arch Surg [Internet]. 2005 Mar [cited 2020 Feb 13];140(3):278–83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15781793
  • 7. Fagard K, Casaer J, Wolthuis A, Flamaing J, Milisen K, Lobelle JP, et al. Postoperative complications in individuals aged 70 and over undergoing elective surgery for colorectal cancer. Color Dis. 2017;19(9):O329–38.
  • 8. Huang Z-X, Zhou Z, Shi H-R, Li T-Y, Ye S-P. Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center. World J Gastrointest Surg. 2021;13(12):1660–72.
  • 9. Loogman L, de Nes LCF, Heil TC, Kok DEG, Winkels RM, Kampman E, et al. The Association Between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients With Colorectal Cancer. Dis Colon Rectum. 2021;64(11):1342–53.
  • 10. Park EJ, Baik SH, Kang J, Hur H, Min BS, Lee KY, et al. The Impact of Postoperative Complications on Long-term Oncologic Outcomes after Laparoscopic Low Anterior Resection for Rectal Cancer. Med (United States). 2016;95(14):1–9.
  • 11. Tevis SE, Kennedy GD. Postoperative complications and implications on patient-centered outcomes. Vol. 181, Journal of Surgical Research. 2013. p. 106–13.
  • 12. Couwenberg AM, de Beer FSA, Intven MPW, Burbach JPM, Smits AB, Consten ECJ, et al. The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study. J Geriatr Oncol [Internet]. 2018;9(2):102–9. Available from: https://doi.org/10.1016/j.jgo.2017.09.005
  • 13. Pinto A, Faiz O, Davis R, Almoudaris A, Vincent C. Surgical complications and their impact on patients’psychosocial well-being:a systematic review and meta-analysis. BMJ Open. 2016;6.
  • 14. Breugom AJ, van Dongen DT, Bastiaannet E, Dekker FW, van der Geest LGM, Liefers GJ, et al. Association Between the Most Frequent Complications After Surgery for Stage I–III Colon Cancer and Short-Term Survival, Long-Term Survival, and Recurrences. Ann Surg Oncol. 2016;23(9):2858–65.
  • 15. McSorley ST, Horgan PG, McMillan DC. The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2016;97:168–77.
  • 16. Tohme S, Simmons RL, Tsung A. HHS Public Access (102). Surg Cancer A Trigger Metastases Samer. 2018;77(7):1548–52.
  • 17. Lindholm S, Academy TS, Gamage DB. The Clavien-Dindo Classification a useful tool in measuring postoperative complications following colorectal cancer surgery at Colombo South Teaching Hospital Degree Project in Medicine. 2020; 18. Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The clavien-dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250(2):187–96.
  • 19. Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: Risk factors and preventive strategies [Internet]. Vol. 4, Patient Safety in Surgery. 2010 [cited 2020 Feb 13]. p. 5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20338045
  • 20. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis [Internet]. 1987 [cited 2021 Jun 26];40(5):373–83. Available from: https://pubmed.ncbi.nlm.nih.gov/3558716/
  • 21. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992 Dec;111(5):518–26.
  • 22. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
  • 23. Sheng S, Tiancheng Z, Wang X. Comparison of robot-assisted surgery,laparoscopic-assisted surgery, and open surgeryfor the treatment of colorectal cancer. Medicine (Baltimore). 2018;97(34):e11817.
  • 24. Ng KT, Tsia AK V, Chong VYL. Robotic Versus Conventional Laparoscopic Surgeryfor Colorectal Cancer: A Systematic Review and Meta-Analysiswith Trial Sequential Analysis. World J Surg. 2019;43:1146–61.
  • 25. Cengiz H, Aygin D. Validity and reliability study of the Turkish version of the postoperative recovery index of patients undergoing surgical intervention. Turkish J Med Sci. 2019;49(2):566–73.
  • 26. Yolcu S, Akın S. Ortopedi , Kalp ve Genel Cerrahi Ameliyatları Sonrası Dönemde Hastaların İyileşme Durumları ve Bakım Gereksinimlerinin Değerlendirilmesi. Sağlık ve Toplum. 2015;25(3):33–45.
  • 27. Zhang J, Du Z, Bi J, Wu Z, Lv Y, Zhang X, et al. The impact of previous abdominal surgery on clinical characteristics and prognosis of pyogenic liver abscess: A 10-year retrospective study of 392 patients. Med (United States). 2018;97(39):2–7. 28. Seetahal S, Obirieze A, Cornwell EE, Fullum T, Tran D. Open abdominal surgery: A risk factor for future laparoscopic surgery? Am J Surg [Internet]. 2015;209(4):623–6. Available from: http://dx.doi.org/10.1016/j.amjsurg.2014.12.017
  • 29. Husain F, Jeong IH, Spight D, Wolfe B, Mattar SG. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res. 2018;95(2):94–9.
  • 30. Procter LD, Davenport DL, Bernard AC, Zwischenberger JB. General Surgical Operative Duration Is Associated with Increased Risk-Adjusted Infectious Complication Rates and Length of Hospital Stay. J Am Coll Surg [Internet]. 2010;210(1):60-65.e2. Available from: http://dx.doi.org/10.1016/j.jamcollsurg.2009.09.034
  • 31. Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad PhD B, Ferko NC, Cameron CG, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res [Internet]. 2018;229:134–44. Available from: https://doi.org/10.1016/j.jss.2018.03.022
  • 32. Harrison OJ, Smart NJ, White P, Brigic A, Carlisle ER, Allison AS, et al. Operative Time and Outcome of Enhanced RecoveryAfter Surgery After Laparoscopic Colorectal Surgery. J Soc Laparoendosc Surg. 2014;18:265–72.
  • 33. Lobato LF de C, Ferreira PCA, Wick EC, Kiran RP, Remzi FH, Kalady MF, et al. Risk factors for prolonged length of stay after colorectal surgery. J Coloproctology. 2013;33(1):22–7.
  • 34. Ahmed Ali U, Dunne T, Gurland B, Vogel JD, Kiran RP. Actual versus estimated length of stay after colorectal surgery: Which factors influence a deviation? Am J Surg [Internet]. 2014;208(4):663–9. Available from: http://dx.doi.org/10.1016/j.amjsurg.2013.06.004
  • 35. Huebner M, Hübner M, Cima RR, Larson DW. Timing of complications and length of stay after rectal cancer surgery. J Am Coll Surg. 2014;218(5):914–9.
There are 33 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Articles
Authors

Hatice Yüceler Kaçmaz 0000-0003-4529-1991

Muhammet Akyüz 0000-0002-2002-8698

Hilal Kahraman 0000-0001-6389-8039

Seda Akutay 0000-0002-2843-8392

Özlem Ceyhan 0000-0002-1869-8713

Early Pub Date January 8, 2024
Publication Date January 5, 2024
Acceptance Date November 28, 2023
Published in Issue Year 2023 Issue: 21 - December

Cite

APA Yüceler Kaçmaz, H., Akyüz, M., Kahraman, H., Akutay, S., et al. (2024). Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi(21), 903-919. https://doi.org/10.38079/igusabder.1173461
AMA Yüceler Kaçmaz H, Akyüz M, Kahraman H, Akutay S, Ceyhan Ö. Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar. IGUSABDER. January 2024;(21):903-919. doi:10.38079/igusabder.1173461
Chicago Yüceler Kaçmaz, Hatice, Muhammet Akyüz, Hilal Kahraman, Seda Akutay, and Özlem Ceyhan. “Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar”. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi, no. 21 (January 2024): 903-19. https://doi.org/10.38079/igusabder.1173461.
EndNote Yüceler Kaçmaz H, Akyüz M, Kahraman H, Akutay S, Ceyhan Ö (January 1, 2024) Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi 21 903–919.
IEEE H. Yüceler Kaçmaz, M. Akyüz, H. Kahraman, S. Akutay, and Ö. Ceyhan, “Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar”, IGUSABDER, no. 21, pp. 903–919, January 2024, doi: 10.38079/igusabder.1173461.
ISNAD Yüceler Kaçmaz, Hatice et al. “Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar”. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi 21 (January 2024), 903-919. https://doi.org/10.38079/igusabder.1173461.
JAMA Yüceler Kaçmaz H, Akyüz M, Kahraman H, Akutay S, Ceyhan Ö. Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar. IGUSABDER. 2024;:903–919.
MLA Yüceler Kaçmaz, Hatice et al. “Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar”. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi, no. 21, 2024, pp. 903-19, doi:10.38079/igusabder.1173461.
Vancouver Yüceler Kaçmaz H, Akyüz M, Kahraman H, Akutay S, Ceyhan Ö. Kolorektal Kanser Cerrahi Geçiren Hastalarda Clavien-Dindo Sınıflandırma Sistemine Göre Postoperatif Komplikasyonlar. IGUSABDER. 2024(21):903-19.

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