Outcomes Based on Risk Assessment of Anastomotic Leakage after Rectal Cancer Surgery

Gong, Jian-Ping; Yang, Liu; Huang, Xin-En; Sun, Bei-Cheng; Zhou, Jian-Nong; Yu, Dong-Sheng; Zhou, Xin; Li, Dong-Zheng; Guan, Xin; Wang, Dong-Feng

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자료유형: 학술저널

저자정보: Gong, Jian-Ping (Breast Cancer Center, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) Yang, Liu (Colorectal Cancer Center, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) Huang, Xin-En (Department of Chemotherapy, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) Sun, Bei-Cheng (Department of Generai Surgery, the First Affiliated Hospital with Nanjing Medical University) Zhou, Jian-Nong (Breast Cancer Center, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) Yu, Dong-Sheng (Breast Cancer Center, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) Zhou, Xin (Breast Cancer Center, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) Li, Dong-Zheng (Breast Cancer Center, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu In) Guan, Xin Wang, Dong-Feng

저널정보: 아시아태평양암예방학회 Asian Pacific journal of cancer prevention : APJCP Asian Pacific journal of cancer prevention : APJCP 제15권 제2호

발행연도: 2014.1

수록면: 707 - 712 (6page)

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Purpose: Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates, and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Data for 460 patients who underwent primary anterior resection with a double stapling technique for rectal carcinoma at a single institution from 2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation. Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according to ICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logistic regression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysed using the Cox regression method. Results: AL was noted in 35 (7.6%) of 460 patients with rectal cancer. :Median age of the patients was 65 (50-74) and 161 (35%) were male. The diagnosis of AL was made between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004), gender (p=0.007), tumor site (p<0.001), preoperative body mass index (EMI) (p<0.001), the reduction of TSGF on 5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD (p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survival of the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level EMI related (p=0.007) and advanced TNM stage related <p<0.001). Conclusions: AL after anterior resection for rectal carcinoma is related to advanced age, low tumor site, male sex, high preoperative EMI, low pH value of pelvic drainage on POD 3 and a significant reduction of TSGF on POD 5. In addition to their high risk of immediate postoperative morbidity and mortality, AL, worse physical status, severe obesity and advanced TNM stage have similarly negative impact on survival.

#Rectal cance #anastomotic leak #survival analysis #anterior resection

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Gong, Jian-Ping

소속기관 Department of General Surgery, Nanjing Medical University Affiliated Jiangsu Cancer Hospital