Toyoshima Akira, Nishizawa Toshihiro, Sunami Eiji, Akai Ryuji, Amano Takahiro, Yamashita Akiyoshi, Sasaki Shin, Endo Takeshi, Moriya Yoshihiro, Toyoshima Osamu
Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan.
Department of Gastroenterology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan.
World J Gastrointest Surg. 2020 Oct 27;12(10):425-434. doi: 10.4240/wjgs.v12.i10.425.
Intersphincteric resection (ISR) has been increasingly used as the ultimate sphincter-preserving procedure in extremely low rectal cancer. The most critical complication of this technique is anastomotic leakage. The incidence rate of anastomotic leakage after ISR has been reported to range from 5.1% to 20%.
To investigate risk factors for anastomotic leakage after ISR based on clinicopathological variables and pelvimetry.
This study was conducted at Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo, Japan, with a total of 117 patients. We enrolled 117 patients with extremely low rectal cancer who underwent laparotomic and laparoscopic ISRs at our hospital. We conducted retrospective univariate and multivariate regression analyses on 33 items to elucidate the risk factors for anastomotic leakage after ISR. Pelvic dimensions were measured using three-dimensional reconstruction of computed tomography images. The optimal cutoff value of the pelvic inlet plane area that predicts anastomotic leakage was determined using a receiver operating characteristic (ROC) curve.
We observed anastomotic leakage in 10 (8.5%) of the 117 patients. In the multivariate analysis, we identified high body mass index (odds ratio 1.674; 95% confidence interval: 1.087-2.58; = 0.019) and smaller pelvic inlet plane area (odds ratio 0.998; 95% confidence interval: 0.997-0.999; = 0.012) as statistically significant risk factors for anastomotic leakage. According to the receiver operating characteristic curves, the optimal cutoff value of the pelvic inlet plane area was 10074 mm. Narrow pelvic inlet plane area (≤ 10074 mm) predicted anastomotic leakage with a sensitivity of 90%, a specificity of 85.9%, and an accuracy of 86.3%.
Narrow pelvic inlet and obesity were independent risk factors for anastomotic leakage after ISR. Anastomotic leakage after ISR may be predicted from a narrow pelvic inlet plane area (≤ 10074 mm).
括约肌间切除术（ISR）越来越多地被用作极低位直肠癌保留括约肌的最终手术方式。该技术最关键的并发症是吻合口漏。据报道，ISR术后吻合口漏的发生率在5.1%至20%之间。
基于临床病理变量和骨盆测量研究ISR术后吻合口漏的危险因素。
本研究在日本东京日本红十字会医疗中心结直肠外科进行，共纳入117例患者。我们纳入了117例在我院接受开腹和腹腔镜ISR的极低位直肠癌患者。我们对33项指标进行了回顾性单因素和多因素回归分析，以阐明ISR术后吻合口漏的危险因素。使用计算机断层扫描图像的三维重建测量骨盆尺寸。使用受试者工作特征（ROC）曲线确定预测吻合口漏的骨盆入口平面面积的最佳截断值。
117例患者中有10例（8.5%）发生吻合口漏。在多因素分析中，我们确定高体重指数（比值比1.674；95%置信区间：1.087 - 2.58；P = 0.019）和较小的骨盆入口平面面积（比值比0.998；95%置信区间：0.997 - 0.999；P = 0.012）是吻合口漏的统计学显著危险因素。根据受试者工作特征曲线，骨盆入口平面面积的最佳截断值为10074 mm²。狭窄的骨盆入口平面面积（≤10074 mm²）预测吻合口漏的敏感性为90%，特异性为85.9%，准确性为86.3%。
狭窄的骨盆入口和肥胖是ISR术后吻合口漏的独立危险因素。ISR术后吻合口漏可通过狭窄的骨盆入口平面面积（≤10074 mm²）进行预测。
