Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: case-control study using propensity score matching method
Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: case-control study using propensity score matching method
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DOI：
10.1016/j.amjsurg.2013.07.047
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发表时间：
2014-06-01
影响因子：
3
通讯作者：
Kim, Young Jin
中科院分区：
文献类型：
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作者：
Kim, Hun Jin;Huh, Jung Wook;Kim, Young Jin
背景技术背景：直肠癌术后吻合口瘘的肿瘤学影响仍存在争议。方法：回顾性分析1999年1月至2010年12月期间，1,148例直肠癌患者接受保肛根治术。使用倾向评分匹配法，328例使用纤维蛋白胶的患者与328例未使用纤维蛋白胶的患者进行匹配，并比较匹配组的肿瘤结局。多因素分析显示，纤维蛋白胶是预防吻合口瘘的独立预测因子。在656个匹配组中，吻合口瘘患者的5年局部无复发生存率和无疾病生存率显著低于无吻合口瘘患者。多变量分析证实，吻合口漏是一个独立的局部复发和无病生存的预后因素，但纤维蛋白胶的使用是不相关的长期结果时，控制confronters.Conclusions：吻合口漏是一个主要的独立预后因素，长期的结果。生物胶具有吻合口保护作用，无肿瘤学优势。(C)2014爱思唯尔公司All rights reserved.
BACKGROUND: The oncologic impact of anastomotic leakage after rectal cancer surgery remains controversial.METHODS: Between January 1999 and December 2010, 1,148 patients with rectal cancer who underwent curative surgery with sphincter preservation were retrospectively reviewed. Using the propensity score matching method, 328 patients with fibrin glue were matched to 328 patients without fibrin glue, and oncologic outcomes were compared in the matched groups.RESULTS: Anastomotic leakage was diagnosed in 76 patients (6.6%). On multivariate analysis, fibrin glue was the independent predictor of prevention of anastomotic leakage. In the 656 matched groups, patients with anastomotic leakage had significantly worse 5-year local recurrence-free survival and disease-free survival than those without leakage. Multivariate analysis confirmed that anastomotic leakage was an independent prognostic factor of both local recurrence and disease-free survival, but the use of fibrin glue was not associated with the long-term outcomes when controlling for confounders.CONCLUSIONS: Anastomotic leakage is a major independent prognostic factor for long-term outcomes. Fibrin glue has a protective effect of anastomosis, without oncologic advantages. (C) 2014 Elsevier Inc. All rights reserved.