Zheng Hongtu, Wu Zhenyu, Wu Yuchen, Mo Shanjing, Dai Weixing, Liu Fangqi, Xu Ye, Cai Sanjun
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong An Road, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
Int J Colorectal Dis. 2019 Feb;34(2):319-328. doi: 10.1007/s00384-018-3199-z. Epub 2018 Nov 23.
Anastomotic leakage is still one of the most dreaded complications after anterior resection for rectal cancer. This study aimed to identify risk factors for anastomotic leakage and to create a nomogram for precise prediction of anastomotic leakage after anterior resection for rectal cancer.
Two thousand six hundred eighteen consecutive patients who underwent anterior resection for rectal cancer with primary anastomosis, with or without diverting stoma, were retrospectively analyzed as a training dataset. Univariate and multivariable Cox regression analyses were used to determine independent risk factors associated with anastomotic leakage. A nomogram was constructed to predict anastomotic leakage. Data containing 611 patients were prospectively collected as a test dataset. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots.
The rate of clinical anastomotic leakage was 9.3% in the training dataset. Multivariate analysis identifies the following variables as independent risk factors for anastomotic leakage: gender (male) (odds ratio (OR) = 2.286), distance of tumor to anal verge (OR = 0.791), tumor size (OR = 1.175), operating time (OR = 1.009), diabetes mellitus (OR = 1.704), laparoscopic surgery (OR = 0.445), anastomotic bleeding (OR = 13.46), and diverting stoma (OR = 0.386). We created a nomogram with high discriminative ability (concordance index, 0.722). The area under the curve value, which evaluated the predictive performance of external validation, was 0.723.
A protective diverting stoma and laparoscopic surgery significantly decrease the risk of anastomotic leakage. Our nomogram was a useful tool for precise prediction of anastomotic leakage after anterior resection for rectal cancer.
吻合口漏仍是直肠癌前切除术后最可怕的并发症之一。本研究旨在确定吻合口漏的危险因素，并创建一个列线图以精确预测直肠癌前切除术后的吻合口漏。
对2618例接受直肠癌前切除并进行一期吻合（有或无转流造口）的连续患者进行回顾性分析，作为训练数据集。采用单因素和多因素Cox回归分析确定与吻合口漏相关的独立危险因素。构建列线图以预测吻合口漏。前瞻性收集包含611例患者的数据作为测试数据集。通过自举一致性指数和校准图评估列线图的性能。
训练数据集中临床吻合口漏发生率为9.3%。多因素分析确定以下变量为吻合口漏的独立危险因素：性别（男性）（比值比（OR）=2.286）、肿瘤距肛缘距离（OR=0.791）、肿瘤大小（OR=1.175）、手术时间（OR=1.009）、糖尿病（OR=1.704）、腹腔镜手术（OR=0.445）、吻合口出血（OR=13.46）和转流造口（OR=0.386）。我们创建了一个具有高辨别能力的列线图（一致性指数，0.722）。评估外部验证预测性能的曲线下面积值为0.723。
保护性转流造口和腹腔镜手术可显著降低吻合口漏的风险。我们的列线图是精确预测直肠癌前切除术后吻合口漏的有用工具。
