Luo Yan, Liu Jian, Huang Jiong, Ma Liya, Li Zhen
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, China.
Cancer Med. 2025 May;14(9):e70933. doi: 10.1002/cam4.70933.
Anastomotic leakage (AL) is a severe postoperative complication in colorectal cancer and exerts negative impacts on patients' outcomes. Studies have found that body composition measured by CT images was associated with increased overall postoperative complications in colorectal cancer; however, few focused on postoperative AL in rectal cancer. This study aimed to explore the association between body composition parameters measured by CT images and postoperative AL in patients with rectal cancer, with an emphasis on subgroup analysis by gender.
From February 2014 to January 2020, a total of 444 patients with rectal adenocarcinoma who underwent radical proctectomy were included. Out of all patients, 21 developed AL after surgery. Body composition parameters, including the areas, mean CT values, height-normalized indices of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), intramuscular adipose tissue (IMAT) and skeletal muscle (SM) were derived from preoperative contrast-enhanced arterial phase CT images at the third lumbar level. The ratio of visceral to subcutaneous adipose tissue (VSR) was calculated. Clinical and body composition parameters were compared between the AL group and the non-AL group in all patients and separately in different genders.
Body composition parameters were not significantly different in the AL group and the non-AL group in all patients. However, most body composition parameters were significantly different between male and female patients. After separately analyzing by gender, VSR was significantly associated with postoperative AL in male and female. After multivariate regression, VSR remained an independent predictor for AL (OR: 0.1, p = 0.041 for male and OR: 39.1, p = 0.045 for female).
The VSR measured by CT images is an independent predictor for postoperative AL in patients with rectal cancer; however, it shows gender differences in opposite directions, serving as a protective factor in males, whereas as a risk factor in females.
吻合口漏（AL）是结直肠癌严重的术后并发症，对患者预后产生负面影响。研究发现，通过CT图像测量的身体成分与结直肠癌术后总体并发症增加有关；然而，很少有研究关注直肠癌术后的AL。本研究旨在探讨通过CT图像测量的身体成分参数与直肠癌患者术后AL之间的关联，并着重按性别进行亚组分析。
纳入2014年2月至2020年1月期间共444例行根治性直肠切除术的直肠腺癌患者。所有患者中，21例术后发生AL。身体成分参数，包括皮下脂肪组织（SAT）、内脏脂肪组织（VAT）、肌内脂肪组织（IMAT）和骨骼肌（SM）的面积、平均CT值、身高标准化指数，均来自术前第三腰椎水平的对比增强动脉期CT图像。计算内脏与皮下脂肪组织的比值（VSR）。比较所有患者以及不同性别患者中AL组和非AL组的临床和身体成分参数。
所有患者中，AL组和非AL组的身体成分参数无显著差异。然而，男性和女性患者之间的大多数身体成分参数存在显著差异。按性别分别分析后，VSR与男性和女性患者的术后AL均显著相关。多因素回归分析后，VSR仍然是AL的独立预测因素（男性：OR=0.1，p=0.041；女性：OR=39.1，p=0.045）。
通过CT图像测量的VSR是直肠癌患者术后AL的独立预测因素；然而，它在不同性别中显示出相反方向的差异，在男性中是保护因素，而在女性中是危险因素。
