中低位直肠癌保肛直肠切除术后吻合口漏的危险因素及肿瘤学影响：日本多机构队列研究
Risk Factors for and Oncologic Impact of Anastomotic Leakage After Sphincter-Preserving Proctectomy for Mid/Low Rectal Cancer: A Multi-institutional Cohort Study in Japan.
作者信息
Ochiai Kentaro, Hida Koya, Yamaguchi Tomohiro, Fukuda Meiki, Akagi Tomonori, Akiyoshi Takashi, Okamura Ryosuke, Yamamoto Seiichiro, Naitoh Takeshi, Konishi Tsuyoshi
机构信息
Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
出版信息
Ann Surg Oncol. 2025 Jul 7. doi: 10.1245/s10434-025-17763-2.
BACKGROUND
Anastomotic leakage after sphincter-preserving proctectomy is a serious postoperative complication. It is unclear whether diverting ostomy prevents anastomotic leakage, and whether anastomotic leakage worsens long-term oncologic outcomes.
PATIENTS AND METHODS
Data from patients with stage II-III mid/low rectal cancer who underwent sphincter-preserving proctectomy between January 2010 and December 2011 were retrospectively analyzed using a multicenter database from 69 institutions. Factors associated with anastomotic leakage and its influence on oncologic outcomes were evaluated.
RESULTS
A total of 922 patients were included. Anastomotic leakage was diagnosed in 125 patients (13.6%). Anastomotic leakage was associated with increased reoperations (29.6% vs. 1.0%, p < 0.0001), longer hospital stays (median 34 days vs. 15 days, p < 0.0001), and more frequent permanent ostomy (20.8% vs. 11.0%, p = 0.002). Multivariable analysis revealed that absence of diverting ostomy (odds ratio 2.46, 95% confidential interval 1.59-3.85, p = 0.0004) and male sex (odds ratio 2.54, 95% confidence interval 1.58-4.26, p = 0.001) were independently associated with an increased risk of anastomotic leakage. The risk reduction with diverting ostomy was observed in both sexes in interaction term analysis. Anastomotic leakage was associated with an increased risk of local recurrence in patients with pathologic stage III disease (hazard ratio 2.11, 95% confidence interval 1.08-4.14, p = 0.03) but was not associated with overall or recurrence-free survival.
CONCLUSIONS
Absence of diverting ostomy and male sex were risk factors for anastomotic leakage, and anastomotic leakage was associated with increased local recurrence in patients with stage III disease. These findings support the practice of protective diversion after sphincter-preserving proctectomy in patients with mid/low rectal cancer.
背景
保留括约肌的直肠切除术后吻合口漏是一种严重的术后并发症。目前尚不清楚转流性造口是否能预防吻合口漏，以及吻合口漏是否会使长期肿瘤学结局恶化。
患者与方法
使用来自69家机构的多中心数据库，对2010年1月至2011年12月期间接受保留括约肌直肠切除术的II - III期 中/低位直肠癌患者的数据进行回顾性分析。评估与吻合口漏相关的因素及其对肿瘤学结局的影响。
结果
共纳入922例患者。125例患者（13.6%）被诊断为吻合口漏。吻合口漏与再次手术增加（29.6% 对1.0%，p < 0.0001）、住院时间延长（中位34天对15天，p < 0.0001）以及更频繁的永久性造口（20.8% 对11.0%，p = 0.002）相关。多变量分析显示，未行转流性造口（比值比2.46，95% 置信区间1.59 - 3.85，p = 0.0004）和男性（比值比2.54，95% 置信区间1.58 - 4.26，p = 0.001）与吻合口漏风险增加独立相关。在交互项分析中，无论男女，转流性造口均可降低风险。吻合口漏与病理III期疾病患者局部复发风险增加相关（风险比2.11，95% 置信区间1.08 - 4.14，p = 0.03），但与总生存期或无复发生存期无关。
结论
未行转流性造口和男性是吻合口漏的危险因素，吻合口漏与III期疾病患者局部复发增加相关。这些发现支持对中/低位直肠癌患者在保留括约肌的直肠切除术后进行保护性转流的做法。
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