Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea.
Am J Surg. 2014 Jun;207(6):840-6. doi: 10.1016/j.amjsurg.2013.07.047. Epub 2013 Nov 9.
The oncologic impact of anastomotic leakage after rectal cancer surgery remains controversial.
Between January 1999 and December 2010, 1,148 patients with rectal cancer who underwent curative surgery with sphincter preservation were retrospectively reviewed. Using the propensity score matching method, 328 patients with fibrin glue were matched to 328 patients without fibrin glue, and oncologic outcomes were compared in the matched groups.
Anastomotic leakage was diagnosed in 76 patients (6.6%). On multivariate analysis, fibrin glue was the independent predictor of prevention of anastomotic leakage. In the 656 matched groups, patients with anastomotic leakage had significantly worse 5-year local recurrence-free survival and disease-free survival than those without leakage. Multivariate analysis confirmed that anastomotic leakage was an independent prognostic factor of both local recurrence and disease-free survival, but the use of fibrin glue was not associated with the long-term outcomes when controlling for confounders.
Anastomotic leakage is a major independent prognostic factor for long-term outcomes. Fibrin glue has a protective effect of anastomosis, without oncologic advantages.
直肠癌手术后吻合口漏的肿瘤学影响仍存在争议。
回顾性分析 1999 年 1 月至 2010 年 12 月期间 1148 例接受保肛手术的直肠癌患者。采用倾向评分匹配法，将 328 例使用纤维蛋白胶的患者与 328 例未使用纤维蛋白胶的患者进行匹配，并比较匹配组的肿瘤学结果。
76 例（6.6%）患者诊断为吻合口漏。多因素分析显示，纤维蛋白胶是预防吻合口漏的独立预测因素。在 656 对匹配组中，吻合口漏患者的 5 年局部无复发生存率和无病生存率明显低于无漏患者。多因素分析证实，吻合口漏是局部复发和无病生存的独立预后因素，但在控制混杂因素后，使用纤维蛋白胶与长期结果无关。
吻合口漏是长期结果的一个主要独立预后因素。纤维蛋白胶对吻合口有保护作用，但没有肿瘤学优势。
