Risk factors analysis of anastomotic leakage after rectal cancer surgery in the elderly from 2015 to 2020

doi:10.3877/cma.j.issn.1674-3946.2022.01.017

Abstract

Abstract:

Objective

To analyze the risk factors of anastomotic leakage in senile rectal cancer patients.

Methods

The data of 390 elderly patients underwent laparoscopic radical resection of rectal cancer from December 2015 to December 2020 were retrospectively analyzed，and they were divided into anastomotic leakage group（n=25 cases）and no anastomotic leakage group（n=365 cases）according to the occurrence of postoperative anastomotic leakage. SPSS19.0 software was used for data analysis，χ² test was used for univariate analysis，multivariate logistic regression analysis was performed for statistically significant univariate analysis results. P<0.05 was considered statistically significant.

Results

Preoperative albumin ≤35 g/L，operation time >3 h，anastomosis distance ≤7 cm from anal margin，intestinal obstruction and vascular invasion were the high risk factors for postoperative anastomotic leakage.

Conclusion

In order to avoid the occurrence of postoperative anastomotic leakage in elderly patients with rectal cancer，preoperative albumin，operation time，anastomotic distance from anal margin，intestinal obstruction and vascular invasion are the key indicators of clinical attention.

Key words: Aged, Rectal neoplasms, Postoperative complications, Anastomotic leakage, Risk factors

Yuansheng Tong, Bao Jiang, Tao Zheng, Xiang Yin. Risk factors analysis of anastomotic leakage after rectal cancer surgery in the elderly from 2015 to 2020[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(01): 56-58.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2022.01.017

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2022/V16/I01/56

Figures/Tables 2

References 21

[1]	贺荔枝，李克亚，曾娟妮，等. 血清AIb、PA、NLR水平在直肠癌术后发生吻合口瘘评估中的应用［J］. 现代生物医学进展，2021，21（13）：2508-2511，2483.
[21]	姚宏伟，张忠涛. 腹腔镜直肠癌根治术的热点与未来发展［J/CD］.中华普外科手术学杂志（电子版），2019，13（1）：1-4.
[3]	余德红，梅思俊. 腹腔镜直肠癌术后吻合口瘘发生情况及其影响因素［J］.临床医学工程，2021，28（6）：843-844.
[4]	李柱，廖信芳，吕海钠，等. 血清CRP、腹腔引流液CRP在预测腹腔镜结直肠癌术后吻合口瘘的临床价值［J］. 广州医科大学学报，2021，49（3）：77-82.
[5]	吴清，陈海军，周进. 腹腔镜直肠癌根治保肛术后吻合口漏的危险因素分析及预防［J/CD］. 中华普外科手术学杂志（电子版），2021，15（1）：303-305.
[6]	王得胜，叶钢，冯平，等. 腹腔镜直肠癌根治保肛术后吻合口漏的危险因素分析及预防［J］. 湖北科技学院学报（医学版），2016，30（4）：303-305.
[7]	曾祥岳，孙振强，王海江. 734例直肠癌术后吻合口漏的影响因素分析［J］. 中华肿瘤防治杂志，2016，23（5）：322-325.
[8]	秦敬. 腹腔镜低位直肠癌保肛术后吻合口漏的危险因素分析及预防对策［J］. 临床外科杂志，2017，25（7）：531-533.
[9]	张展志，肖萌萌，李雁，等. 腹腔镜直肠癌保肛手术后吻合口漏的危险因素与对策［J］. 中华肿瘤防治杂志，2016，23（1）：40-44.
[10]	吕强，姜协，颜荣林. 双吻合器技术在直肠癌保肛手术中吻合口漏的危险因素分析［J］. 中国癌症杂志，2017，27（11）：903-907.
[11]	赵丽君. 直肠癌前切除术后吻合口漏的危险因素分析［J］. 基层医学论坛，2017，21（1）：52-53.
[12]	徐谊，赵晓牧，孙武青，等. 直肠癌低位前切除术后吻合口漏发生相关因素分析［J］. 首都医科大学学报，2017，38（5）：727-732.
[13]	余向南，付达安，戴拯，等. 直肠癌前切除术吻合口漏预防及治疗［J/CD］. 中华普外科手术学杂志（电子版），2021，15（5）：587-590.

因素	例数	吻合口漏组（n=25）	无吻合口漏组（n=365）	χ²	P
性别
男性	209	14	195	0.062	>0.05
女性	181	11	170	0.062	>0.05
术前白蛋白（g/L）
≤35	236	20	216	5.21	<0.05
>35	154	5	149	5.21	<0.05
手术时间（min）
≤3 h	250	5	245	22.58	<0.01
>3 h	140	20	120	22.58	<0.01
合并高血压
是	102	6	96	0.06	>0.05
否	288	19	269	0.06	>0.05
合并糖尿病
是	73	4	69	0.13	>0.05
否	317	21	296	0.13	>0.05
吻合口距肛缘距离（cm）
≤7	278	19	259	1.04	0.001
>7	112	6	106	1.04	0.001
肠梗阻
是	92	20	72	47.15	<0.01
否	298	5	293	47.15	<0.01
Dukes分期
A、B期	239	14	225	0.1	>0.05
C、D期	151	11	140	0.1	>0.05
BMI（kg/m²）
≤24	238	13	225	0.91	>0.05
>24	152	12	140	0.91	>0.05
出血量（ml）
≤500	265	18	247	0.20	>0.05
>500	125	7	118	0.20	>0.05
血管侵犯
是	43	13	30	45.00	<0.01
否	347	12	335	45.00	<0.01
神经侵犯
是	52	6	46	14.98	<0.01
否	338	19	319	14.98	<0.01

因素	例数	吻合口漏组（n=25）	无吻合口漏组（n=365）	χ²	P
性别
男性	209	14	195	0.062	>0.05
女性	181	11	170	0.062	>0.05
术前白蛋白（g/L）
≤35	236	20	216	5.21	<0.05
>35	154	5	149	5.21	<0.05
手术时间（min）
≤3 h	250	5	245	22.58	<0.01
>3 h	140	20	120	22.58	<0.01
合并高血压
是	102	6	96	0.06	>0.05
否	288	19	269	0.06	>0.05
合并糖尿病
是	73	4	69	0.13	>0.05
否	317	21	296	0.13	>0.05
吻合口距肛缘距离（cm）
≤7	278	19	259	1.04	0.001
>7	112	6	106	1.04	0.001
肠梗阻
是	92	20	72	47.15	<0.01
否	298	5	293	47.15	<0.01
Dukes分期
A、B期	239	14	225	0.1	>0.05
C、D期	151	11	140	0.1	>0.05
BMI（kg/m²）
≤24	238	13	225	0.91	>0.05
>24	152	12	140	0.91	>0.05
出血量（ml）
≤500	265	18	247	0.20	>0.05
>500	125	7	118	0.20	>0.05
血管侵犯
是	43	13	30	45.00	<0.01
否	347	12	335	45.00	<0.01
神经侵犯
是	52	6	46	14.98	<0.01
否	338	19	319	14.98	<0.01

因素	Wald χ²值	P值	OR值	95%CI
术前白蛋白≤35 g/L	7.89	<0.05	1.58	0.95~2.16
手术时间>3 h	9.74	<0.05	1.97	1.18~2.86
吻合口距肛缘距离≤7 cm	8.81	<0.05	1.79	1.06~2.45
肠梗阻	6.38	<0.05	1.32	0.84~1.86
血管侵犯	11.36	<0.05	2.43	1.36~3.17

因素	Wald χ²值	P值	OR值	95%CI
术前白蛋白≤35 g/L	7.89	<0.05	1.58	0.95~2.16
手术时间>3 h	9.74	<0.05	1.97	1.18~2.86
吻合口距肛缘距离≤7 cm	8.81	<0.05	1.79	1.06~2.45
肠梗阻	6.38	<0.05	1.32	0.84~1.86
血管侵犯	11.36	<0.05	2.43	1.36~3.17

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[2]	Liuqing Li, Xiaoxiang Chen, Chengyu Lv. Comparison of total laparoscopic and laparoscopic assisted radical gastrectomy in the treatment of advanced gastric cancer in the near and medium term [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 23-26.
[3]	Shijun Liu, Jie Ma, Lujing Shi. Near-and medium-term follow-up study of complete mesangectomy plus standard D2 radical resection for advanced gastric cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 27-30.
[4]	Lixia Zhao, Chunxia Wang, Yifeng Chen, Dongping Hu, Weisheng Zhang, Tao Wang, Honglai Zhang. Effects of visceral obesity on early complications after laparoscopic radical resection for rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 35-39.
[5]	Hui Wu, Yongjun Nai, Xuesong Shi, Xiaowei Wei. Comparison of the effect of lateral lymph node dissection in descending rectal cancer by two anatomic approaches [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 40-43.
[6]	Huazhi Li, Guang Cao, Diangang Liu, Yajing Zhang. Clinical comparison of descending hepatectomy with different approaches for primary hepatocellular carcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 52-55.
[7]	Xiaowei Chang, Yu Cai, Zhiyong Zhao, Wei Zhang. Efficacy and safety analysis of high intensity focused ultrasound ablation combined with hepatic arterial chemoembolization in the treatment of primary hepatocellular carcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 56-59.
[8]	Yinan Xu. Curative effect of different operation methods in the treatment of obstructive left colorectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 72-75.
[9]	Lu Wang, Lijun Zhou. Effects of different anastomotic methods in total laparoscopic distal subtotal gastrectomy on gastric function recovery and complication rate in patients with gastric cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 92-95.
[10]	Minhua Zheng, Tianyu Jiang, Xuan Zhao, Junjun Ma. 30 years historical development and future outlook of laparoscopic surgery for rectal cancer in China [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 591-595.
[11]	Pan Chi, Shenghui Huang. The tremendous progress in laparoscopic radical surgery for rectal cancer over the past three decades in China [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 596-600.
[12]	Ming Li, Shong Tu, Peng Yan, Jun Qian, Pengcheng Gao, Wenshan Xu, Faying Yang, Zhentao Hu, Yongwei Shan. Research on the application of prostate resection endoscopy guided catheterization for the treatment of rectal low anastomosis leakage [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 603-606.
[13]	Ling Li, Ya Liu, Peiling Li, Xiumin Zhang, Ping Li. Study on the relationship between postoperative intestinal flora and depression in patients with rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 607-610.
[14]	Zijun Zhao, Yunsheng Lan. Effect of modified one-shot terminal ileostomy on stress response and safety after anal preservation for low rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 611-614.
[15]	Shirui Yan, Hui Xiong. Identification of risk factors for acute kidney injury in patients with infective endocarditis and prediction of death risk in such patients with acute kidney injury [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 618-624.

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