Neoadjuvant Chemoradiotherapy For Rectal Cancer:Causes Of Anastomotic Leakage After Dixon And The Necessity Of Preventive Stoma

Objectives:To investigate the reasons of anastomotic leakage and the necessity of preventive stoma after anterior resection of the rectum after the rectum neoadjuvant chemoradiotherapy(nCRT).Methods:128 patients 56.69±10.608 years old with Dixon after nCRT in the First Affiliated Hospital of Kunming Medical University from September 2016 to September 2018 was retrospectively analyzed,single factor(P<0.05 for statistical difference);Binary Logistic multivariate regression analysis was performed on single-factor variables related to postoperative anastomotic leakage(P<0.05 was considered statistically significant);preventive stoma was explored on hospital stay,eating time,operative time,and surgical bleeding,independent by sample T test.(P<0.05 was considered statistically significant)Results:A total of 128 patients with standard age,age 56.69±10.608 years old,12 patients had anastomotic leakage after operation,and the incidence of anastomotic stoma was 9.3%.Diabetes,preoperative albumin,preventive stoma,anastomotic distance from anal margin<5cm,EMVI(extravertebral vessels Invasion),gender related to the occurrence of anastomotic leakage;binary logistics multivariate regression analysis of single-factor variables related to postoperative anastomotic leakage,the results showed that with diabetes,preoperative albumin,anastomotic distance from the anal margin were Independent risk factors for anastomotic leakage after Dixon after nCRT;preventive stoma shortened hospital stay and shortened postoperative feeding time,but there was no significant difference in surgical bleeding and surgery time.Conclusion(s):(1)Gender,diabetes mellitus,preoperative albumin level,anastomotic distance from anal margin,preventive ostomy,EMVI were associated with the occurrence of anastomotic leakage after nCRT for rectal cancer Dixon;(2)Diabetes,preoperative albumin level,anastomotic distance from anal margin were independent risk factors affecting the occurrence of anastomotic leakage in patients after Dixon after nCRT(3)preventive stoma shortened the hospitalization time and shortened the postoperative feeding time.There was no significant difference in the operation time and intraoperative bleeding.For patients with high risk of anastomotic leakage,prophylactic ostomy was recommended.Preventive stoma should be selected in patients after Dixon surgery after nCRT for rectal cancer with high-risk.