Wang Lei, Zhang Wang-Shan, Huang Guo-Jin
Department of General Surgery, The Second Hospital of Nanjing, Nanjing 210009, Jiangsu Province, China.
World J Gastrointest Surg. 2024 Dec 27;16(12):3710-3719. doi: 10.4240/wjgs.v16.i12.3710.
Anastomotic leakage (AL) is a significant complication of rectal cancer surgery, particularly in patients undergoing neoadjuvant chemoradiotherapy. This study aimed to evaluate the onset and prognostic factors influencing AL in these patients and provide insights for better postoperative management.
To explore AL incidence in patients who underwent neoadjuvant radiotherapy for rectal cancer and evaluate influencing factors and prognosis.
We retrospectively analyzed data of patients with rectal cancer who underwent neoadjuvant chemoradiotherapy post-radical surgery admitted to our hospital from January 2020 to January 2023. Postoperative AL was recorded in all patients. Among 63 patients with AL initially enrolled, 2 were lost to follow-up; thus, 61 patients were included in the incident group. Another 59 patients without AL were included in the non-incident group. Clinical characteristics of both groups were analyzed to identify factors affecting postoperative AL and determine prognosis.
Multivariate analysis revealed that sex, operative time, bleeding, pelvic radiation injury, and intraoperative blood transfusion were independent risk factors for postoperative AL ( < 0.05). The Swiss Institute for Experimental Cancer Research (ISREC) grades for patients with postoperative AL were mainly A (49.18%) and B (40.98%), and most leakages occurred in the posterior wall (65.57%). Clinical manifestations included anal sacrococaudal pain (29.51%), anal pus (26.23%), and other symptoms. Invasive interventions were performed < 2 times in 80.33% of patients. Poor prognoses were mainly associated with chronic pressacral sinus formation (24.59%), anastomotic stenosis (29.51%), and long-term stoma (19.67%). Multivariate analysis revealed distance from the anal margin and ISREC grade as independent risk factors for poor prognosis following AL ( < 0.05).
Sex, operative time, bleeding loss, pelvic radiation damage, and intraoperative blood transfusion are independent risk factors for AL and the distance between tumor and ISREC grade potentially affect prognosis.
吻合口漏（AL）是直肠癌手术的一种严重并发症，尤其是在接受新辅助放化疗的患者中。本研究旨在评估这些患者中AL的发生情况及影响因素，并为更好的术后管理提供见解。
探讨接受直肠癌新辅助放疗患者的AL发生率，评估影响因素及预后。
我们回顾性分析了2020年1月至2023年1月在我院接受根治性手术后行新辅助放化疗的直肠癌患者的数据。记录所有患者术后的AL情况。最初纳入的63例发生AL的患者中，2例失访；因此，61例患者被纳入发病组。另外59例未发生AL的患者被纳入非发病组。分析两组的临床特征，以确定影响术后AL的因素并判断预后。
多因素分析显示，性别、手术时间、出血量、盆腔放射性损伤和术中输血是术后AL的独立危险因素（<0.05）。术后发生AL患者的瑞士癌症实验研究所（ISREC）分级主要为A级（49.18%）和B级（40.98%），且大多数漏口发生在吻合口后壁（65.57%）。临床表现包括骶尾部肛门疼痛（29.51%）、肛门流脓（26.23%）及其他症状。80.33%的患者进行侵入性干预的次数<2次。预后不良主要与慢性骶前窦形成（24.59%）、吻合口狭窄（29.51%）和长期造口（19.67%）有关。多因素分析显示，距肛缘距离和ISREC分级是AL后预后不良的独立危险因素（<0.05）。
性别、手术时间、失血量、盆腔放射性损伤和术中输血是AL的独立危险因素，肿瘤距肛缘距离和ISREC分级可能影响预后。
