Risk Factors And The Management Of Anastomotic Leakage After Dixon Operation For Rectal Cancer

Objective To research the factor associated with anastomotic leakage after Dixon operation for rectal cancer and investigate the preventive measures.Methods Clinical data of 962 cases was analyzed including gender, age,diabetes mellitus,hypertension, albumin,hemoglobin,neoadjuvant therapy,tumor size, distance from the tumor to the analverge,operation method,tumor invasion depth,type of the tumor,pathological pattern,doctor level,lymphatic metastasis of the persons who underwent anus-preserving operation by dalian medical university affiliated hospital between 2003 and 2014.Results Of the 962 cases after anus-preserving operaton,832 cases after open operation and 130 cases after the laparoscopic surgery, 39 cases developed anastomotic leakage,the occurrence rate was 4.1%(39/962).1. The results of single factor annalysis hint :gender,diabetes mellitus,albumin and distance from the tumor to the analverge have statistically significant.A total of 539 cases with male,28 cases developed anastomotic leakage,the occurrence rate was5.8%(28/539) compared with 2.7% for female.A total of 97 cases with diabetes mellitus,8 cases developer anastomotic leakage,the occurrence rate was 8.2%compared with 3.6% for patients without diabetes.The incidence of postoperative anastomotic leakage in the patients with serum albumin level <35g/l was 8.4%compared with 3.6%.The patients with distance from tumor to analverge ≤5cm was 106 cases,9 cases of them was occurrence with anastomotic leakage,the occurrence rate was10% compared with 3.3% for the cases with distance >5cm.the other clinical dataincluding age,hypertension,,neoadjuvant therapy,tumor size, operation method,tumor invasion depth,type of the tumor,pathological pattern,doctor level,lymphatic metastasis were not related with anastomotic leakage.2. Use the 4 clinical data(gender,diabetes,albumin level,the distance from tumor to analverge) to make multi-factor logstic analysis shows that men(OR=2.810,95%CI:1.262-6.255,P=0.011),diabetes(OR=0.308,95%CI:0.131-0.725,P=0.007),distance from tumor to analverge(OR=3.460,95%CI:1.585-7.549,P=0.002) were independent risk factors for anastomotic leakage.among them,the distance≤5cm was the biggest risk factor.3. According to the result of multi-factor analysis,statisticl cases containing the biggest risk fator results suggest:A total 42 men with the distance ≤5cm,of which occurred ananstomotic leakage,the occurrence rate was 8.9%.Conclusion male, diabetes,distance from tumor to analverge≤5cm were independent risk factors for rectal cancer anastomotic leakage.in clinical work,we should pay attention to them who were male with distance≤5cm.These groups were more likely to happen anastomotic leakage,dotctors should formulate the effective solutions before operations and use individual reasonable prevention measures to avoid the occurrence of anastomotic leakage.