Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer
Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer
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DOI：
10.5387/fms.2019-17
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发表时间：
2020-01-01
影响因子：
0.8
通讯作者：
Kono, Koji
中科院分区：
文献类型：
--
作者：
Sakamoto, Wataru;Ohki, Shinji;Kono, Koji
目的：吻合口瘘是直肠癌手术中最严重的并发症之一。AL不仅会导致生活质量下降、住院时间延长和排便功能受损，而且局部复发率也很高。在这项研究中，我们调查了AL的危险因素，因为它可能有助于减少其发生并改善患者的预后。方法：本研究是一项回顾性、单机构研究，研究对象是2002年4月至2018年2月在福岛医科大学医院接受择期低位前切除术的直肠癌患者。根据AL的存在将患者分为两组。采用单因素和多因素分析检查患者、肿瘤和手术相关变量。结果：161例患者入组，平均年龄63.5±11.5岁。总AL率为6.8%（11/161）。在单因素分析中，改良格拉斯哥预后评分(mGPS)=2 (p=0.003)，使用多个吻合器（>= 3次）进行直肠切除术（p=0.001）和术中出血（>= 250 g）与AL发生率显著相关。多因素分析发现，mGPS = 2（比值比[OR]: 19.6, 95%可信区间[CI]: 2.96 ~ 125.00, p = 0.002）和多次点火（OR: 18.19, CI: 2.31 ~ 111.11, p = 0.002）是AL的独立危险因素。结论：mGPS评分较高和多次点火是AL的独立危险因素。
Objective : Anastomotic leakage (AL) is one of the most devastating complications of rectal cancer surgery. Not only does AL result in reduced quality of life, extended hospitalization and impaired defecatory function, it also has a high local recurrence rate. In this study, we investigated risk factors for AL as it may help to decrease its occurrence and improve patient outcomes.Methods : This study was a retrospective, single institution study of rectal cancer patients who underwent elective low anterior resection between April 2002 and February 2018 at Fukushima Medical University Hospital. Patients were divided into two groups according to the presence of AL. Patient, tumor, and surgery related variables were examined using univariate and multivariate analyses.Results : One hundred sixty one patients, average age 63.5 +/- 11.5 years, were enrolled in the study. The overall AL rate was 6.8% (11/161). In the univariate analysis, modified Glasgow Prognostic Score (mGPS)=2 (p=0.003), use of multiple staplers (>= 3 firings) for rectal transection (p=0.001) and intraoperative bleeding (>= 250 g) were significantly associated with AL incidence. Multivariate analysis identified that mGPS = 2 (odds ratio [OR] : 19.6, 95% confidence interval [CI] : 2.96-125.00, p = 0.002) and multiple firings (OR : 18.19, CI : 2.31-111.11, p = 0.002) were independent risk factors for AL.Conclusion : Higher mGPS score and multiple firings were independent risk factors for AL.