Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
BMC Cancer. 2024 Jul 12;24(1):834. doi: 10.1186/s12885-024-12544-8.
In this study, we aimed to identify the risk factors in patients with rectal anastomotic re-leakage and develop a prediction model to predict the probability of rectal anastomotic re-leakage after stoma closure.
This study was a single-center retrospective analysis of patients with rectal cancer who underwent surgery between January 2010 and December 2020. Among 3225 patients who underwent Total or Partial Mesorectal Excision (TME/PME) surgery for rectal cancer, 129 who experienced anastomotic leakage following stoma closure were enrolled. Risk factors for rectal anastomotic re-leakage were analyzed, and a prediction model was established for rectal anastomotic re-leakage.
Anastomotic re-leakage after stoma closure developed in 13.2% (17/129) of patients. Multivariable analysis revealed that neoadjuvant chemoradiotherapy (odds ratio, 4.07; 95% confidence interval, 1.17-14.21; p = 0.03), blood loss > 50 ml (odds ratio, 4.52; 95% confidence interval, 1.31-15.63; p = 0.02), and intersphincteric resection (intersphincteric resection vs. low anterior resection: odds ratio, 6.85; 95% confidence interval, 2.01-23.36; p = 0.002) were independent risk factors for anastomotic re-leakage. A nomogram was constructed to predict the probability of anastomotic re-leakage, with an area under the receiver operating characteristic curve of 0.828 in the cohort. Predictive results correlated with the actual results according to the calibration curve.
Neoadjuvant chemoradiotherapy, blood loss > 50 ml, and intersphincteric resection are independent risk factors for anastomotic re-leakage following stoma closure. The nomogram can help surgeons identify patients at a higher risk of rectal anastomotic re-leakage.
本研究旨在确定直肠吻合口再漏患者的危险因素，并建立预测模型来预测造口关闭后直肠吻合口再漏的概率。
这是一项单中心回顾性分析，纳入了 2010 年 1 月至 2020 年 12 月间接受直肠癌手术的患者。在 3225 例接受全直肠系膜切除术（TME）/部分直肠系膜切除术（PME）治疗直肠癌的患者中，有 129 例在造口关闭后发生吻合口漏。分析了直肠吻合口再漏的危险因素，并建立了直肠吻合口再漏的预测模型。
129 例患者中有 17 例（13.2%）发生造口关闭后的吻合口再漏。多变量分析显示，新辅助放化疗（比值比，4.07；95%置信区间，1.17-14.21；p=0.03）、出血量＞50ml（比值比，4.52；95%置信区间，1.31-15.63；p=0.02）和经括约肌间切除术（经括约肌间切除术与低位前切除术相比：比值比，6.85；95%置信区间，2.01-23.36；p=0.002）是吻合口再漏的独立危险因素。建立了预测吻合口再漏概率的列线图，在队列中的受试者工作特征曲线下面积为 0.828。根据校准曲线，预测结果与实际结果相关。
新辅助放化疗、出血量＞50ml 和经括约肌间切除术是造口关闭后吻合口再漏的独立危险因素。该列线图可帮助外科医生识别吻合口再漏风险较高的患者。
