Risk Factors Of Anastomotic Leakage After Colorectal Cancer Operation

Objective:To analyze the related risk factors of postoperative anastomotic leakage of colorectal cancer,and to provide reference for the prevention and treatment of postoperative anastomotic leakage of colorectal cancer.Methods:Retrospective analysis was performed on patients who underwent colorectal cancer surgery in the Gastrointestinal Department of our hospital from January 2015 to September 2020.A total of 756 patients who met the criteria were included,including 437 cases of colon cancer and319 cases of rectal cancer.The risk factors related to postoperative anastomotic leakage of colorectal cancer were analyzed from four aspects of individual factors,surgical factors,preoperative laboratory examination,and tumor-related factors,including 25 indicators.In this study,three groups were set up,including colorectal cancer group,colon cancer group and rectal cancer group.Univariate analysis of counting data was performed by X 2 test,and independent risk factors analysis of postoperative anastomotic leakage was performed by binary Logistic regression analysis.Results:1.Of the 756 patients who had undergone colorectal cancer surgery,anastomotic leakage occurred in 76 patients(10.1%),including 8.5%(37/437)after colorectal cancer surgery and 12.2%(39/319)after rectal cancer surgery.In the colorectal cancer group,unifactorialX~2analysis showed that gender,smoking,preoperative intestinal obstruction,emergency surgery,open surgery,intraoperative blood loss≥300ml and operation time≥180min were related risk factors for postoperative anastomotic leakage(p<0.05).Multivariate Logistic analysis showed that emergency surgery(P=0.001,OR=0.244),open surgery(p<0.001,OR=3.706),intraoperative blood loss≥300ml(p<0.001,OR=0.130),operation time≥180min(p<0.001,OR=0.342)were independent risk factors for postoperative anastomotic leakage of colorectal cancer.2.Univariate analysis of related risk factors for colon cancer group showed that gender,smoking,alcohol consumption,intestinal obstruction before surgery,emergency surgery,open surgery,intraoperative blood loss≥300ml,operative time≥180min and albumin<35g/L were related risk factors for postoperative anastomotic leakage of colon cancer(p<0.05).Multivariate Logistic analysis showed that emergency surgery(p=0.003,OR=0.234),open surgery(p=0.033,OR=3.622),intraoperative blood loss≥300ml(p<0.001,OR=0.180),operation time≥180min(p=0.012,OR=0.354)were the independent risk factors for postoperative anastomotic leakage of colon cancer.3.Univariate analysis of related risk factors in the rectal cancer group showed that gender,BMI,smoking,intestinal obstruction before surgery,emergency surgery,open surgery,intraoperative blood loss≥300ml,operative time≥180min,left colonic artery not retained,and tumor distance from anal margin<7cm were related risk factors for anastomotic leakage after rectal cancer(p<0.05).Multivariate Logistic analysis showed that gender(p=0.033,OR=4.084),emergency surgery(p=0.016,OR=0.036),open surgery(p<0.001,OR=8.602),intraoperative blood loss≥300ml(p<0.001,OR=0.040),operation time≥180min(p=0.045,OR=0.361),left colonic artery not preserved(p=0.036,OR=4.316),distance from lower margin of tumor to anal margin<7cm(p=0.014,OR=0.296)were independent risk factors for anastomotic leakage after rectal cancer operation.Conclusion:1.The results of this study showed that the risk factors for postoperative anastomotic leakage of colorectal cancer were mainly operation-related factors,among which emergency surgery,open surgery,intraoperative blood loss≥300ml and operation time≥180min were independent risk factors for postoperative anastomotic leakage of colorectal cancer.2.There was no significant difference in the risk factors related to postoperative anastomotic leakage between colon cancer and rectal cancer.Male patients with low rectal cancer were more prone to anastomotic leakage during rectal cancer surgery,and preserving the left colonic artery can reduce the incidence of anastomotic leakage after operation for rectal cancer.