Risk Factors For Anastomotic Leakage After Anterior Resection Of Rectal Cancer

Objectives: Rectal cancer is the fourth most common malignant tumor in the digestive system,which accounts for about 60% of large intestine cancer.Rectal cancer is the most common site of colorectal cancer.Surgical resection is the first choice for rectal cancer.With the progress of the surgical technique,the total mesorectal excision and the clinical application of new adjuvant treatment before operation,the operation of the low rectal cancer is obviously increased.However,anastomotic leakage after rectal cancer surgery is still a thorny problem for surgeons.Anastomotic leakage can increase the incidence and mortality of postoperative complications of rectal cancer,increase the medical costs and days of hospitalization,even affect the rectal function,local recurrence and long-term survival,which brings great pain to the patients.In recent years,several studies have investigated the risk factors for postoperative anastomotic leakage of rectal cancer,but the incidence of anastomotic leak has not been significantly improved.Therefore,this study investigates the relationship between multiple perioperative factors and anastomotic leakage after anterior resection of rectal cancer in order to provide guidance for the clinical practice of colorectal surgeons.Methods: We consecutively collected 217 patients who underwent rectal cancer resection in the Department of Gastrointestinal Surgery of the First Affiliated Hospital to China Medical University from January 2014 to November 2017.Two researchers independently entry patient related information,tumor related information and operation related information.Patient related information includes patient's age,gender,BMI,NRS2002 score,smoking history,drinking history,history of high blood pressure,history of coronary heart disease,history of diabetes,history of abdominal surgery,ASA grade,preoperative intestinal obstruction,postoperative days 4 albumin,prealbumin,total protein hemoglobin and lymphocyte count.The tumor related data includes the distance from tumor to anal border,tumor location,tumor diameter,TNM staging(UICC staging seven),degree of tumor differentiation.Operation related information includes preoperative bowel preparation,surgery time,ligation level of inferior mesenteric artery(high ligation of inferior mesenteric arterial root and preserving the low ligation of the left colonicc artery),The combination of other organs excision,number of distal rectal cut closure,stapler diameter,the number of Drainage tube,perioperative blood transfusion,postoperative use of non-steroidal analgesics,postoperative diarrhea.Univariate and multivariate analysis of the relationship between 37 variables and anastomotic leakage in the data,in order to investigate the risk factors of anastomotic leakage.All the data analyses are processed through SPSS22.0 software.The continuous variables which don't obey the normal distribution are displayed as median,maximum and minimum while n(%)for the qualitative data.We use univariate logistic regression methods to explore the protential factors which have an influence on the anastomotic leakage after rectal cancer resection.All the variables which have a P value <0.10 are entered in the multivariate logistic regression model.P value <0.05 is considered as statistically significant.Results: 34 patients had anastomotic leakage which constituted 15.7% of total 217 patients.The results of univariate analyses revealed that: anastomotic methods(P=0.03),perioperative blood transfusion(P<0.01),number of distal rectal cut closure(P<0.01),postoperative diarrhea(P<0.01),albumin level(P<0.01),prealbumin level(<0.01),total protein(P=0.03)and lymphocyte count(P<0.01)on postoperative day 4 are significantly associated with anastomotic leakage;multivariate analyses found that: postoperative diarrhea(<0.01),perioperative blood transfusion(P=0.02),number of distal rectal cut closure(P=0.04)and prealbumin level(<0.01)on postoperative day 4 are significantly associated with anastomotic leakage independently.Conclusion: Perioperative blood transfusion,number of distal rectal cut closure,postoperative diarrhea,and low prealbumin level on postoperative day 4 may be independent risk factors for anastomotic leakage after rectal resection.