Shao Sheng-Li, Li Yang-Kun, Qin Ji-Chao, Liu Lu
Department of Surgery, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
World J Gastrointest Surg. 2022 Nov 27;14(11):1250-1259. doi: 10.4240/wjgs.v14.i11.1250.
Anastomotic leakage (AL) is a fatal complication in patients with rectal cancer after undergoing anterior resection. However, the role of abdominal composition in the development of AL has not been studied.
To investigate the relationship between abdominal composition and AL in rectal cancer patients after undergoing anterior resection.
A retrospective case-matched cohort study was conducted. Complete data for 78 patients with AL were acquired and this cohort was defined as the AL group. The controls were matched for the same sex and body mass index (± 1 kg/m). Parameters related to abdominal composition including visceral fat area (VFA), subcutaneous fat area (SFA), subcutaneous fat thickness (SFT), skeletal muscle area (SMA), skeletal muscle index (SMI), abdominal circumference (AC), anterior to posterior diameter of abdominal cavity (APD), and transverse diameter of abdominal cavity (TD) were evaluated based on computed tomography (CT) images using the following Hounsfield Unit (HU) thresholds: SFA: -190 to -30, SMA: -29 to 150, and VFA: -150 to -20. The significance of abdominal composition-related parameters was quantified using feature importance analysis; an artificial intelligence method was used to evaluate the contribution of each included variable.
Two thousand two hundred and thirty-eight rectal cancer patients who underwent anterior resection from 2010 to 2020 in a large academic hospital were investigated. Finally, 156 cases were enrolled in the study. Patients in the AL group showed longer operative time (225.03 ± 55.29 207.17 ± 40.80, = 0.023), lower levels of preoperative hemoglobin (123.32 ± 21.17 132.60 ±1 6.31, = 0.003) and albumin (38.34 ± 4.01 40.52 ± 3.97, = 0.001), larger tumor size (4.07 ± 1.36 2.76 ± 1.28, < 0.001), and later cancer stage ( < 0.001) compared to the controls. Patients who developed AL exhibited a larger VFA (125.68 ± 73.59 97.03 ± 57.66, = 0.008) and a smaller APD (77.30 ± 23.23 92.09 ± 26.40, < 0.001) and TD (22.90 ± 2.23 24.21 ± 2.90, = 0.002) compared to their matched controls. Feature importance analysis revealed that TD, APD, and VFA were the three most important abdominal composition-related features.
AL patients have a higher visceral fat content and a narrower abdominal structure compared to matched controls.
吻合口漏（AL）是直肠癌患者前切除术术后的一种致命并发症。然而，腹部结构在吻合口漏发生过程中的作用尚未得到研究。
探讨直肠癌患者前切除术后腹部结构与吻合口漏之间的关系。
进行一项回顾性病例匹配队列研究。收集了78例吻合口漏患者的完整数据，该队列被定义为吻合口漏组。对照组在性别和体重指数（±1kg/m²）上进行匹配。基于计算机断层扫描（CT）图像，使用以下亨氏单位（HU）阈值评估与腹部结构相关的参数，包括内脏脂肪面积（VFA）、皮下脂肪面积（SFA）、皮下脂肪厚度（SFT）、骨骼肌面积（SMA）、骨骼肌指数（SMI）、腹围（AC）、腹腔前后径（APD）和腹腔横径（TD）：SFA：-190至-30，SMA：-29至150，VFA：-150至-20。使用特征重要性分析对与腹部结构相关的参数的显著性进行量化；采用人工智能方法评估每个纳入变量的贡献。
对一家大型学术医院2010年至2020年接受前切除术的2238例直肠癌患者进行了调查。最终，156例患者纳入研究。与对照组相比，吻合口漏组患者手术时间更长（225.03±55.29对207.17±40.80，P = 0.023），术前血红蛋白水平更低（123.32±21.17对132.60±16.31，P = 0.003）和白蛋白水平更低（38.34±4.01对40.52±3.97，P = 0.001），肿瘤更大（4.07±1.36对2.76±1.28，P<0.001），癌症分期更晚（P<0.001）。发生吻合口漏的患者与匹配的对照组相比，表现出更大的内脏脂肪面积（125.68±73.59对97.03±57.66,P = 0.008）、更小的腹腔前后径（77.30±23.23对92.09±26.40，P<0.001）和腹腔横径（22.90±2.23对24.21±2.90，P = 0.002）。特征重要性分析显示，腹腔横径、腹腔前后径和内脏脂肪面积是与腹部结构相关最重要的三个特征。
与匹配的对照组相比，吻合口漏患者内脏脂肪含量更高，腹部结构更窄。
