Academic Medical Center, Amsterdam, The Netherlands.
Ann Surg. 2017 Nov;266(5):870-877. doi: 10.1097/SLA.0000000000002429.
Little is known about late detected anastomotic leakage after low anterior resection for rectal cancer, and the proportion of leakages that develops into a chronic presacral sinus.
In this collaborative snapshot research project, data from registered rectal cancer resections in the Dutch Surgical Colorectal Audit in 2011 were extended with additional treatment and long-term outcome data. Independent predictors for anastomotic leakage were determined using a binary logistic model.
A total of 71 out of the potential 94 hospitals participated. From the 2095 registered patients, 998 underwent a low anterior resection, of whom 88.8% received any form of neoadjuvant therapy. Median follow-up was 43 months (interquartile range 35-47). Anastomotic leakage was diagnosed in 13.4% within 30 days, which increased to 20.0% (200/998) beyond 30 days. Nonhealing of the leakage at 12 months was 48%, resulting in an overall proportion of chronic presacral sinus of 9.5%. Independent predictors for anastomotic leakage at any time during follow-up were neoadjuvant therapy (odds ratio 2.85; 95% confidence interval 1.00-8.11) and a distal (≤3 cm from the anorectal junction on magnetic resonance imaging) tumor location (odds ratio 1.88; 95% confidence interval 1.02-3.46).
This cross-sectional study of low anterior resection for rectal cancer in the Netherlands in 2011, with almost routine use of neoadjuvant radiotherapy, shows that one third of anastomotic leakages is diagnosed beyond 30 days, and almost half of the leakages eventually do not heal. Chronic presacral sinus is a significant clinical problem that deserves more attention.
对于直肠癌前切除术（low anterior resection，LAR）后迟发吻合口漏，人们知之甚少，也不知道有多少漏口会发展成慢性直肠前窦。
在这个协作快照研究项目中，我们扩展了 2011 年荷兰外科结直肠审计中登记的直肠癌切除术的数据，增加了额外的治疗和长期结果数据。使用二元逻辑模型确定吻合口漏的独立预测因素。
共有 94 家潜在医院中的 71 家参与了研究。在 2095 例登记患者中，998 例行 LAR，其中 88.8%接受了任何形式的新辅助治疗。中位随访时间为 43 个月（四分位距 35-47）。30 天内诊断出吻合口漏的比例为 13.4%，30 天后增加至 20.0%（200/998）。12 个月时漏口未愈合的比例为 48%，导致慢性直肠前窦的总体比例为 9.5%。随访期间任何时间吻合口漏的独立预测因素是新辅助治疗（优势比 2.85；95%置信区间 1.00-8.11）和肿瘤位于远端（磁共振成像上距肛门直肠交界处≤3cm；优势比 1.88；95%置信区间 1.02-3.46）。
本研究为 2011 年荷兰的直肠癌 LAR 回顾性研究，新辅助放疗几乎常规应用，结果显示，1/3 的吻合口漏发生在 30 天后，近一半的漏口最终无法愈合。慢性直肠前窦是一个严重的临床问题，值得更多关注。
