C 反应蛋白-白蛋白比值作为术中应用吲哚菁绿荧光成像行直肠前切除术治疗直肠癌后吻合口漏的危险因素。

C-reactive protein-to-albumin ratio as a risk factor for anastomotic leakage after anterior resection for rectal cancer with intraoperative use of indocyanine green fluorescence imaging.

机构信息

Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-Town, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.

Department of Surgery, Yokohama City University Hospital, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.

出版信息

Surg Endosc. 2024 Aug;38(8):4236-4244. doi: 10.1007/s00464-024-10940-6. Epub 2024 Jun 10.

DOI:10.1007/s00464-024-10940-6

PMID:38858251

Abstract

INTRODUCTION

Indocyanine green fluorescence imaging (ICG-FI) reduces anastomotic leakage (AL) in rectal cancer surgery. However, no studies investigating risk factors for anastomotic leakage specific to the group using ICG-FI have ever previously been conducted. The purpose of this retrospective multicenter study was to ascertain the risk factors for AL in the group using ICG-FI.

METHODS

A total of 638 patients who underwent laparoscopic or robotic anterior resection for rectal cancer between April 2018 and March 2023 were included in this study. Patients were divided into two groups: the ICG-FI group (n = 269) and the non-ICG-FI group (n = 369) for comparative analysis. The effects of clinicopathological and treatment-related factors on AL in the ICG-FI group were evaluated using both univariate and multivariate analyses.

RESULTS

The incidence of AL in the ICG-FI group was 4.8%. Although there was no significant difference in the incidence of AL between the two groups, it was observed to be lower in the ICG-FI group. A multivariate analysis revealed a preoperative C-reactive protein-to-albumin ratio (CAR) ≥ 0.049 (odds ratio, 3.73; 95% confidence interval, 1.01-13.70; p = 0.048) as an independent risk factor for AL in the ICG-FI group.

CONCLUSIONS

In this study, CAR was the only identified risk factor for AL in the ICG-FI group. It was suggested that CAR could be a criterion for early surgical intervention, prior to the escalation of risks, or for considering interventions such as diverting stoma creation.

摘要

简介

吲哚菁绿荧光成像（ICG-FI）可降低直肠癌手术中的吻合口漏（AL）发生率。然而，此前尚未有研究针对使用 ICG-FI 的患者群体，专门调查吻合口漏的危险因素。本回顾性多中心研究的目的是确定使用 ICG-FI 的患者群体中吻合口漏的危险因素。

方法

本研究共纳入了 2018 年 4 月至 2023 年 3 月期间接受腹腔镜或机器人直肠前切除术治疗的 638 例直肠癌患者。将患者分为两组：ICG-FI 组（n=269）和非 ICG-FI 组（n=369）进行对比分析。使用单因素和多因素分析评估了 ICG-FI 组中临床病理和治疗相关因素对 AL 的影响。

结果

ICG-FI 组的 AL 发生率为 4.8%。虽然两组之间的 AL 发生率无显著差异，但 ICG-FI 组的发生率较低。多因素分析显示，术前 C 反应蛋白与白蛋白比值（CAR）≥0.049（比值比，3.73；95%置信区间，1.01-13.70；p=0.048）是 ICG-FI 组 AL 的独立危险因素。