Gerdin Anders, Park Jennifer, Häggström Jenny, Segelman Josefin, Matthiessen Peter, Lydrup Marie-Louise, Rutegård Martin
Department of Diagnostics and Intervention, Surgery, Umeå University, 901 85, Umeå, Sweden.
Department of Surgery, Sahlgrenska University Hospital, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Int J Colorectal Dis. 2024 Dec 2;39(1):193. doi: 10.1007/s00384-024-04766-w.
Anastomotic leakage after rectal cancer surgery is linked to reduced survival and higher recurrence rates. While an aggravated inflammatory response may worsen outcomes, few studies have explored the combined effects of leakage and inflammation.
This is a retrospective multicenter cohort study including patients operated with anterior resection for rectal cancer in Sweden during 2014-2018. Anastomotic leakage within 12 months was exposure and primary outcome was recurrence-free survival. Mediation analysis was performed to evaluate the potential effect of systemic inflammatory response, as measured by the highest postoperative C-reactive protein (CRP) level within 14 days of surgery. Confounders were chosen using a causal diagram.
Some 1036 patients were eligible for analysis, of whom 218 (21%) experienced an anastomotic leakage. At the end of follow-up at a median of 61 months after surgery, recurrence-free survival amounted to 82.6% and 77.8% in the group with and without leakage, respectively. The median highest postoperative CRP value after surgery was higher in the leakage group (219 mg/l), compared with the group without leakage (108 mg/l). Leakage did not lead to worse recurrence-free survival (HR 0.66; 95% CI 0.43-0.94), and there was no apparent effect through postoperative highest CRP (HR 1.12; 95% CI 0.93-1.29).
In conclusion, anastomotic leakage, with its accompanying CRP increase, was not found to be associated with recurrence-free survival after anterior resection for rectal cancer in this patient cohort. Larger, even more detailed studies are needed to further investigate this topic.
直肠癌手术后吻合口漏与生存率降低和复发率升高有关。虽然炎症反应加重可能会使预后恶化，但很少有研究探讨吻合口漏与炎症的联合影响。
这是一项回顾性多中心队列研究，纳入了2014年至2018年期间在瑞典接受直肠癌前切除术的患者。12个月内的吻合口漏为暴露因素，主要结局为无复发生存率。进行中介分析以评估全身炎症反应的潜在影响，通过术后14天内最高的术后C反应蛋白（CRP）水平来衡量。使用因果图选择混杂因素。
约1036例患者符合分析条件，其中218例（21%）发生了吻合口漏。在术后中位61个月的随访结束时，有漏组和无漏组的无复发生存率分别为82.6%和77.8%。漏组术后最高CRP值的中位数（219mg/l）高于无漏组（108mg/l）。吻合口漏并未导致更差的无复发生存率（风险比0.66；95%置信区间0.43 - 0.94），且术后最高CRP也无明显影响（风险比1.12；95%置信区间0.93 - 1.29）。
总之，在该患者队列中，未发现吻合口漏及其伴随的CRP升高与直肠癌前切除术后的无复发生存率相关。需要开展更大规模、更详细的研究来进一步探讨这一主题。
