Relationship Between The Preoperative Nutritional Risk And Anastomotic Leakage Following Antirior Resection For The Rectal Cancer

BackgroundBecause of in-depth understanding of the pelvic anatomy, surgical instruments and surgical techniques improved, the popularity of the concept of the total mesorectal excision (TME) in recent years, the preoperative chemoradiotherapy, as well as the mode of multi-disciplinary cooperation widely used to treatment, the overall level of rectal cancer treatment has been improved, anal sphincter preservation rate was significantly increased in low rectal cancer. Although the various reports on the incidence of rectal cancer anastomotic leakge are not consistent, but the view of anastomotic leakage after surgery for rectal cancer is one of the most serious complications has become to the consensus. Although the continuous development of surgical techniques and surgical instruments, such as circular stapling and double stapling applications significantly improved the security of colorectal anastomosis after rectal anterior resection, anastomotic leakage remains one of the main postoperative complications. Although studies on the risk of anastomotic leskge following rectal anterior resection was more in the past, but the results are not consistent. Age, sex, body weight, tumor remote from the anal margin, nutritional status are the risk factors of anastomotic leakage after resection of rectal cancer were reported in the past, the differences in incidence of postoperative anastomotic leakge following rectal anterior resection in different nutritional status has no further study. Nutrition is important for maintaining human health, patients with cancer often lead to malnutrition due to various reasons, about40%to80%of cancer patients with varying degrees of clinical malnutrition, especially digestive cancer patients, the malnutrition incidence is as high as85%or more. There are many nutrition assessment tools in clinical, the nutritional risk screening(NRS2002) is also more sensitive than other nutritional assessment tools and reflect it’s feasibility. So, we retrospective analysis nutritional risk screening (NRS2002) score, general clinical and pathological data of641patients who underwent elective anterior resection between January2003and July2012at the NanFang Hospital, Southern Medical University, and analysis the relationship between preoperative NRS2002score and postoprative AL by use univariate and multivariate analysis methods.Chapter I Relationship between the preoperative nutritional risk and anastomotic leakage following antirior resection for the rectal cancerObjectiveTo explore the relationship between the preoperative nutritional risk and anastomotic leakage(AL) following antirior resection for the rectal cancer.MethodsData collectionRetrieve the colorectal cancer surgical case management and analysis system of Nanfang Hospital, extract the nutritional risk screening (NRS2002) score, general clinical and pathological data of641patients who underwent elective anterior resection between January2003and July2012at the NanFang Hospital, Southern Medical Universit.Nutritional Risk ScreeningUsing NRS2002scoring system, patients NRS2002score≥3points recognized as nutritious risk.For part of the cases did not undergo preoperative nutritional risk screening, nutritional risk score is recalculated according to the original medical record information.Preoperative preparation, surgery and postoperative treatment All procedures were performed by doctors who have skilled colorectal surgery technology; underwent preoperative mechanical bowel preparation and used in combination of a variety of antibiotics. Strictly abide by the principle of Total Mesorectal Excision (TME) and tumor radical resection intraoperative. Digestive tract reconstruction using the double stapling technique. Protective ostomy by make a transverse colon loop ostomy.Statistical analysisData management uses Access, Chi-squared test and Fisher exact test were used in enumeration data.Binary Logistic regression was used to analyze the risk factors of AL in rectal cancer, The SPSS software13.0analyzed all the data. Probability values <0.05were considered statistically significant.ResultsOf the641patients, NRS2002Score>3and AL occurred in259(40.4%) and26(4.1%) respectively. In univariate analysis,the rate of AL (6.9%) of preoperative nutritional risk group (NRS2002Score≥3) was higher than those(2.1%) in the preoperative nutritional normal group(NRS2002Score<3)(P<0.05). After correct the factors as distance of anastomotic from the anal and tumor clinicopathological staging, multivariate analysis prompted that NRS2002score≥3was a independent risk factor of anastomotic leakage following anterior resection for the rectal cancer (OR=3.198,95%CI1.324～7.722).Conclusion1The preoperative nutritional risk is the independent risk factor of postoperative anastomotic leakage following anterior resection of rectal cancer.2Nutritional Risk Screening (NRS2002) can also be used to predict the risk of single complication as postoperative anastomotic leakage of rectal cancer, this is different from using the NRS2002to judg the overall prognosis situation of a single disease or variety diseases.3There is a high preoperative nutritional risk ratio of patients with rectal anterior resection, we should pay our attention to preoperative nutrition risk screening of patients with anterior resection for rectal cancer.