Wang Zhi-Jie, Tao Jin-Hua, Chen Jia-Nan, Mei Shi-Wen, Shen Hai-Yu, Zhao Fu-Qiang, Liu Qian
Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union College, Beijing 100021, China.
World J Gastrointest Oncol. 2019 Jul 15;11(7):538-550. doi: 10.4251/wjgo.v11.i7.538.
Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL.
To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms.
This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis.
The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group ( = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation ( = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386; 95%CI: 1.808-16.042; = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer.
Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.
术中腹腔内化疗是一种针对局部晚期直肠肿瘤的新兴治疗方式。然而，其对术后并发症的影响尚不清楚。吻合口漏（AL）是直肠肿瘤前切除术相关的最常见且严重的并发症之一。因此，我们设计了本研究以确定术中腹腔内化疗对吻合口漏的影响。
探讨术中腹腔内化疗是否会增加直肠肿瘤前切除术后吻合口漏的发生率。
这项回顾性队列研究收集了2016年9月至2017年9月在我院连续477例行双吻合器技术直肠前切除术患者的信息。根据是否进行术中腹腔内化疗，将患者分为化疗组（171例术中腹腔内植入化疗药物）和对照组（306例未进行术中腹腔内化疗）。记录并分析临床病理特征、术中治疗及术后并发症情况，以确定术中腹腔内化疗对吻合口漏发生率的影响。还通过生存分析比较两组的临床结局。
单因素分析显示，接受术中腹腔内化疗的患者吻合口漏发生率显著更高，化疗组有13例（7.6%），对照组有5例（1.6%）（P = 0.001）。至于吻合口漏的严重程度，接受术中腹腔内化疗的吻合口漏患者往往病情更严重，化疗组13例吻合口漏患者中有12例（92.3%），对照组5例吻合口漏患者中有2例（40.0%）需要二次手术（P = 0.044）。随后进行多因素分析以校正混杂因素，结果也显示术中腹腔内化疗增加了吻合口漏的发生率（比值比 = 5.386；95%可信区间：1.808 - 16.042；P = 0.002）。然而，生存分析表明术中腹腔内化疗也可提高局部晚期直肠癌患者的无病生存率。
术中腹腔内化疗可改善局部晚期直肠癌患者的预后，但也会增加直肠肿瘤前切除术后吻合口漏的风险。
