Liu Yingjun, Wang Gangcheng, Liu Xiaoyong, Hua Pengbiao, Gao Chongqing, Wang Youcai, Han Guangsen
Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):437-441.
To establish a scoring system to predict the risk of anastomotic leakage in patients with rectal cancer older than 60 years.
The study included 995 patients (≥60 years) with rectal cancer locating 3-12 cm from the anal verge who underwent anterior resection or intersphincteric resection at the Department of General Surgery, Henan Cancer Hospital from January 2012 to December 2016. Potential risk factors for leakage were subjected to univariate analysis. Multivariate logistic regression analysis was used to identify the independent risk factors for anastomotic leakage. The scoring system was developed based on regression coefficient for each significant risk factor. One point was allocated to the risk factor with a regression coefficient β<1, and two points were allocated to the risk factor with β>1. The proposed scoring system was tested by the area under curve (AUC) of the receiver operating characteristic curve (ROC).
Surgery was successfully performed in all 995 patients. The incidence of anastomotic fistula was 4.6%(46/995). Among these 46 patients, 31 recovered after conventional treatment, and 13 patients underwent transverse colostomy,and 2 died of multiple organ failure. Independent risk factors included age (β=0.643, OR=1.902, 95%CI: 1.020-3.614, P=0.048), body mass index(BMI) (β=1.218, OR=3.379, 95%CI: 1.607-7.105, P=0.001), albumin levels (β=0.986, OR=2.681, 95%CI: 1.432-5.021, P=0.002), and level of anastomosis from the anal verge (β=1.395, OR=4.034, 95%CI: 2.086-7.801, P=0.000). The scoring system was created base on coefficient β of the independent risk factors (age≥70 years for 1, BMI≥25 kg/m for 2, albumin levels <35 g/L for 1, level of anastomosis from anal verge <4.0 cm for 2). All the scores were added up, and all patients were divided into the high-risk group(4-6 points, n=71) and intermediate-low-risk group(0-3 points, n=924) based on the scoring system. The incidence of anastomotic leakage in the two groups was 23.9%(17/71) and 3.1%(29/924), respectively (χ=60.092, P=0.000). The AUC of age, BMI, albumin levels, and level of anastomosis from the anal verge were 0.598, 0.591, 0.622, and 0.635 respectively. The AUC of the scoring system was 0.656, which was higher than above parameters with a sensitivety of 0.37 and specificity of 0.94.
The scoring system is effective and accurate for identifying a subgroup at high risk for postoperative anastomotic leakage in rectal cancer patients over 60 years old.
建立一种评分系统，以预测60岁以上直肠癌患者吻合口漏的风险。
本研究纳入了995例（≥60岁）距肛缘3-12 cm的直肠癌患者，这些患者于2012年1月至2016年12月在河南省肿瘤医院普通外科接受了前切除术或括约肌间切除术。对潜在的漏出风险因素进行单因素分析。采用多因素logistic回归分析确定吻合口漏的独立危险因素。基于每个显著危险因素的回归系数建立评分系统。回归系数β<1的危险因素得1分，β>1的危险因素得2分。通过受试者操作特征曲线（ROC）的曲线下面积（AUC）对所提出的评分系统进行检验。
995例患者均成功完成手术。吻合口瘘的发生率为4.6%（46/995）。在这46例患者中，31例经传统治疗后康复，13例行横结肠造口术，2例死于多器官功能衰竭。独立危险因素包括年龄（β=0.643，OR=1.902，95%CI：1.020-3.614，P=0.048）、体重指数（BMI）（β=1.218，OR=3.379，95%CI：1.607-7.105，P=0.001）、白蛋白水平（β=0.986，OR=2.681，95%CI：1.432-5.021，P=0.002）以及吻合口距肛缘的位置（β=1.395，OR=4.034，95%CI：2.086-7.801，P=0.000）。根据独立危险因素的系数β建立评分系统（年龄≥70岁得1分，BMI≥25 kg/m²得2分，白蛋白水平<35 g/L得1分，吻合口距肛缘<4.0 cm得2分）。将所有得分相加，根据评分系统将所有患者分为高危组（4-6分，n=71）和中低危组（0-3分，n=924）。两组吻合口漏的发生率分别为23.9%（17/71）和3.1%（29/9
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