| Objective:To evaluation the risk factors of anastomotic leakage after low anterior resection in the past decade and provided some clinical references for the treatment of low rectal cancer.Methods:Through the Official website of Nanchang University Library,PubMed,Embase,The Cochrane Library、CNKI and Wanfang databases were searched for the published literature on postoperative risk factors of anastomotic leakage in patients with rectal cancer after nearly 10 years(2008-2017)at home and abroad.After browsing the articles according to the rigorously established inclusion criterion,a quality assessment was conducted,valid data were extracted,and the collected data was systematically evaluated using RevMan 5.3 tool software.Results:12 articles,5 in English and 7 in Chinese were included with 3945 patients,of which 282 had anastomotic leak after surgery(7.15%).The probability of postoperative anastomotic leak in male was larger than in female(OR=1.43,95%of the CI:1.09-1.87,P=0.009).The risk of postoperative anastomotic leakage in patients with BMI>25kg/m~2 was higher than BMI≤25 kg/m~2(OR=1.58,95%of the CI:1.12-2.23,P=0.01).The risk of postoperative anastomotic leakage in patients whose tumor distance from the anal verge less than 5cm was higher than that<5 cm(OR=4.06,95%of the CI:1.41-11.69 P=0.009).The probability of postoperative anastomotic leakage was larger in patients with Diabetes Mellitus(DM)than those without(OR=2.68,95%of the CI:1.85-3.87,P<0.00001).The risk of postoperative anastomotic leakage in patients with preoperative intestinal obstruction was higher than those without(OR=2.94,95%of the CI:1.87-4.63 P<0.00001).The probability of postoperative anastomotic leakage in patients with distant metastases of tumor was larger than those without(OR=2.26,95%of the CI:1.10-4.64 P=0.03).Patients with low rectal cancer who had postoperative diarrhoea had a larger probability of anastomotic leakage than those without diarrhoea(OR=4.31,95%of the CI:1.71-10.86 P=0.002).Low preoperative albumin levels below 35g/L were associated with an increased risk of postoperative anastomotic leakage compared with patients with albumin levels above 35g/L(OR=4.81,95%of the CI:2.92-7.92 P<0.00001).The incidence of postoperative anastomotic leakage in lower rectal cancer older than 60years was less than patients younger than 60 years old(OR=0.90,95%of the CI:0.61-1.34,P=0.61).The incidence of postoperative anastomotic leakage was higher in patients with rectal cancer older than 65 years of age than in patients younger than 65years old(OR=1.28,95%of the CI:0.85-1.94,P=0.24).The incidence of postoperative anastomotic leak was higher in patients with rectal cancer with tumor size≤4cm than those size>4cm(OR=0.92,95%of the CI:0.65-1.30,P=0.65).The probability of postoperative anastomotic leakage in patients with tumor stage T1 and T2 was larger than those in stage T3 and T4(OR=1.11,95%of the CI:0.77-1.58,P=0.58).The incidence of postoperative anastomotic leakage was higher in patients with low rectal cancer who received radiochemotherapy before surgery than in those without radiochemotherapy(OR=0.7,95%of the CI:0.38-1.28,P=0.24).The incidence of postoperative anastomotic leakage in patients with positive lymph node metastasis was higher than that in patients with negative lymph node metastasis(OR=1.21,95%of the CI:0.75-1.93,P=0.44).The probability of anastomotic leakage in patients with preoperative hemoglobin levels>100 g/L after surgery was larger than those with Hb levels<100 g/L(OR=1.4,95%of the CI:0.78-2.50,P=0.26).The probability of anastomotic leakage in patients with low rectal cancer after surgery was larger without preventive stoma than those with preventive stoma(OR=1.55,95%CI:0.91-2.66,P=0.11).Conclusions:1.Male,BMI>25kg/m~2,extent of the neoplasm from the anal edge less than5cm,DM,preoperative intestinal obstruction,distant metastases of the tumor,postoperative diarrhoea,and preoperative albumin level<35g/L are considered risk factors for postoperative anastomotic leakage in patients with low rectal cancer.2.The analysis revealed there was no statistical significance in terms of age,tumor diameter,carcinoma T staging,preoperative radiochemotherapy,lymph node diffusion,preoperative Hb level,and preventive stoma. |
PDF Full Text Request