Northern Jiangsu People's Hospital Affiliated to Medical School of Nanjing University, Yangzhou, 225001, China.
Northern Jiangsu People's Hospital, Yangzhou, China.
Int J Colorectal Dis. 2023 May 22;38(1):139. doi: 10.1007/s00384-023-04438-1.
Postoperative anastomotic leakage for rectal cancer shows higher morbidity with grievous concomitant symptoms. Accurate assessment of the incidence of anastomotic leakage, multivariate analysis, and establishment of a scientific prediction model can be useful to dispose of its possible severe clinical consequences.
This retrospective study collected 1995 consecutive patients who underwent anterior resection of rectal cancer with primary anastomosis at Northern Jiangsu People's Hospital between January 2016 and June 2022. Independent risk factors associated with anastomotic leakage were analyzed by univariate and multivariate logistic regression. The chosen independent risk factors were used to construct a nomogram risk prediction model whose availability was evaluated by using a bootstrapped-concordance index and calibration plots with R software.
A total of 1995 patients who underwent anterior resection for rectal cancer were included while 120 patients were diagnosed with anastomotic leakage, an incidence of 6.0%. Univariate analysis and its concomitant multivariate cox regression analysis indicated that independent risk factors associated with anastomotic leakage included male gender (odds ratio (OR) = 2.873), diabetes (OR = 2.480), neoadjuvant therapy (OR = 5.283), tumor's distance from the anus verge < 5 cm (OR = 5.824), tumor size ≥ 5 cm (OR = 4.888), and the blood lose > 50 mL (OR = 9.606).We established a nomogram prediction model with proper applicability (concordance index, 0.83) and the calibration curve to justify its predictive ability that the predicted occurrence probability keeps a high degree of consistency with the actual occurrence probability. Meanwhile, the area under the receiver operating characteristic (ROC) curve was 0.83.
The characteristics of patients and tumor surgery-related conditions can affect the incidence of anastomotic leakage. However, whether the surgical method will affect morbidity is still controversial. Our nomogram can be seen as an effective instrument to predict anastomotic leakage after anterior resection for rectal cancer precisely.
直肠癌术后吻合口漏具有较高的发病率和严重的伴随症状。准确评估吻合口漏的发生率、进行多变量分析并建立科学的预测模型，有助于处理其可能的严重临床后果。
本回顾性研究收集了 2016 年 1 月至 2022 年 6 月期间在苏北人民医院接受直肠前切除术和原发吻合术的 1995 例连续患者。通过单变量和多变量逻辑回归分析与吻合口漏相关的独立危险因素。选择独立的危险因素来构建列线图风险预测模型，并用 R 软件的bootstrap-一致性指数和校准图来评估其可用性。
共纳入 1995 例接受直肠前切除术的直肠癌患者，其中 120 例诊断为吻合口漏，发病率为 6.0%。单因素分析及其伴随的多因素 Cox 回归分析表明，与吻合口漏相关的独立危险因素包括男性（比值比（OR）=2.873）、糖尿病（OR=2.480）、新辅助治疗（OR=5.283）、肿瘤距肛缘<5cm（OR=5.824）、肿瘤大小≥5cm（OR=4.888）和出血量>50mL（OR=9.606）。我们建立了一个具有适当适用性的列线图预测模型（一致性指数，0.83）和校准曲线，以证明其预测能力，即预测发生概率与实际发生概率保持高度一致。同时，接受者操作特征（ROC）曲线下面积为 0.83。
患者特征和肿瘤手术相关条件会影响吻合口漏的发生率。然而，手术方法是否会影响发病率仍存在争议。我们的列线图可以被视为一种准确预测直肠癌前切除术后吻合口漏的有效工具。
