Abstract
Objective:Anastomotic Leakage (AL) is one of the most common complications after resection of rectal cancer. Recognition of the incidence and risk factors related to AL is important. This study aimed develops a model that can predict anastomotic leakage after anterior rectal resection.Methods:Data from 188 patients undergoing anterior resection of rectal cancer were collected for retrospective analysis. Patients were randomly divided in the development set and validation set at a 1:1 ratio. We first included age, sex, preoperative chemoradiotherapy, tumor size, degree of tumor differentiation, stage, TNM stage, lymph vascular invasion, distance, anastomotic method, diabetes, intraoperative time, intraoperative bleeding and smoking as candidates for variable selection with a LASSO method. A ROC curve was constructed with the validation set to assess the accuracy of the prediction model.Results:AL occurred in 20 of 188 patients (10.6%). Preoperative chemoradiotherapy (p=0.04), medium degree of tumor differentiation (p=0.04), anastomotic method (p<0.01), intraoperative bleeding≥400ml (p<0.01), smoking (p<0.01), diabetes (p<0.01) were significantly related to AL. The area under the ROC curve of the prediction model is 0.952.Conclusions:This study developed a model that can predict anastomotic leakage after anterior rectal resection, which may aid the selection of preventive ileostomy and postoperative management.
Highlights
Rectal cancer is the third most common malignant tumor in the world
We aimed to develop a risk model to predict the occurrence of postoperative anastomotic leakage (AL) and aid the proper selection of preventive ileostomy
The patient-related variables, tumorrelated variables, and surgery-related variables were selected for univariate analysis (Table-I) and the degree of tumor differentiation, the distance between the lower edge of the tumor and the anal margin, anastomotic method, diabetes, intraoperative time, intraoperative bleeding and smoking history were significantly associated with AL (p
Summary
Rectal cancer is the third most common malignant tumor in the world. The incidence in China has been increasing at a rate of 4.2% per year.[1] Surgery has been a common treatment approach for rectal cancer. Anastomotic leakage (AL) is one of the most frequent complications after the resection of rectal tumors. The incidence of postoperative AL in rectal cancer is 3%-13%.2,3. It can cause serious consequences such as pelvic abscesses, peritonitis, sepsis, septic shock and even death. AL is the main course of long-term complications such as postoperative anastomotic stenosis and bowel dysfunction. Significant progress has been made in the stapler, operation technique
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