Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer
Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer
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DOI：
10.1007/s00268-007-9451-2
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发表时间：
2008-06-01
影响因子：
2.6
通讯作者：
Chun, Ho-Kyung
中科院分区：
文献类型：
--
作者：
Lee, Won-Suk;Yun, Seong Hyeon;Chun, Ho-Kyung
背景吻合口漏是直肠手术的主要并发症。本研究的目的是确定直肠癌患者低位前切除术（LAR）后吻合口瘘的危险因素，并研究其对长期预后和疾病的影响。方法回顾性分析1996年10月至2006年2月间行直肠癌根治术并在盆腹膜反射下一期吻合的患者，结果LAR术后发生吻合口漏51例（4.0%）。至渗漏的中位时间为4天（范围= 2-30天）。在单变量分析中，性别、吻合口水平小于4 cm、术前伴随放化疗（CCRT）和手术时间大于120 min与吻合口漏显著相关。在多变量分析中，性别（p = 0.041;相对风险= 2.007; 95%CI = 1.030-3.912）和术前CCRT（p = 0.003;相对风险= 2.861; 95%CI = 1.417-5.778）被确定为独立的预后因素。无渗漏组和渗漏组的总生存率分别为80.2%和64.9%（p = 0.170）。无吻合口瘘组与吻合口瘘组5年无瘤生存率无显著性差异（78.1%vs.65.9%，p = 0.166）。男性和术前CCRT与直肠癌术后吻合口瘘风险增加相关。在本系列中未发现吻合口漏对局部复发的影响。
Background Anastomosis leakage is a major complication of rectal surgery. The aim of this study was to identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on long-term prognosis and disease-free survival and overall survival in rectal cancer patients.Methods Consecutive patients who underwent rectal resection with primary anastomosis below the pelvic peritoneal reflexion for rectal cancer between October 1996 to February 2006 were included.Results Anastomosis leakage after LAR occurred in 51 patients (4.0%). The median time to leakage was 4 days (range = 2-30 days). In univariate analysis, gender, level of anastomosis less than 4 cm, preoperative concomitant chemoradiation (CCRT), and length of operation greater than 120 min were significantly associated with anastomosis leakage. In a multivariate analysis, gender (p = 0.041; relative risk = 2.007; 95% CI = 1.030-3.912) and preoperative CCRT (p = 0.003; relative risk = 2.861; 95% CI = 1.417-5.778) were identified as independent prognostic factors. The overall survival of the nonleakage group and the leakage group was 80.2% and 64.9%, respectively (p = 0.170). The 5-year disease-free survival rates were not significantly different between the nonleakage and leakage groups (78.1% vs. 65.9%, p = 0.166).Conclusions The incidence of anastomotic leakage after low anterior resection is relatively low. Male gender and preoperative CCRT were associated with increased risk for anastomotic leakage after rectal cancer surgery. No effect of anastomosis leakage on local recurrence was found in this series.