Analysis Of Related Factors Of Anastomotic Leakage After Laparoscopic Low Anterior Resection Of Rectal Cancer

BackgroundRectal cancer is one of the most common malignant tumors of digestive tract at present.Surgical resection is still the main treatment for rectal cancer.Especially for early and middle-stage tumors,radical resection of tumors is the main means to improve the survival rate and prognosis of patients.With the progress and development of laparoscopic technology,the number of laparoscopic resection of rectal cancer is increasing.In the Provincial Hospital Affiliated to Shandong University and some other large medical centers,laparoscopic surgery has gradually replaced open surgery as the main surgical method of rectal cancer resection.However,as with traditional surgery,patients after laparoscopic resection of rectal cancer still face the risk of anastomotic leakage.Documents at home and abroad have pointed out that anastomotic leakage after operation may be related to preoperative age,sex,nutritional status,location of tumors,diameter of tumors and other factors,but comprehensive related research shows that different research institutions have not reached a consistent conclusion on the risk factors that may cause anastomotic leakage after operation.Therefore,it is important to identify the high risk factors of anastomotic leakage after laparoscopic resection of rectal cancer for reducing the incidence of leakage and improving the prognosis of patients.ObjectivesTo identify the high risk factors of anastomotic leakage in patients undergoing laparoscopic resection of rectal cancer in our hospital,and to provide reference and basis for surgeons in clinical work.MethodsA retrospective study was conducted to collect the data of patients who underwent laparoscopic LAR in gastrointestinal surgery ward of Provincial Hospital Affiliated to Shandong University from January 1,2015 to June 30,2017.The eligible patients were included iN the study according to clear inclusion and exclusion criteria.There were 18 indicators,including patient factors,tumor factors and surgical factors.Among them,8 were patient factors,including gender,age,BMI,history of diabetes mellitus,preoperative hemoglobin level,preoperative albumin level,ASA anesthesia risk rating,post-operative infection;5 were tumor factors,including distance between tumors and anal margin,combined obstruction,diameter of tumors,type of tumors,lymph node.Node metastasis;5 operative factors,including anastomotic reinforcement,closure of pelvic peritoneum,intraoperative intraperitoneal infusion chemotherapy,prophylactic ileostomy,surgeon.SPSS22.0 was used to analyze and process the research data.First,single factor analysis was carried out.The measurement data were tested by independent sample t test or rank sum test according to the normal distribution.Pearson Chi square test,continuity correction Chi square test or Fisher exact probability test were used for the counting data according to the actual frequency.Univariate indicators with significant statistical significance were analyzed,and multivariate logistic regression analysis was carried out.P<0.05 was used as a statistical index.ResultsA total of 628 cases were included in this study.32 cases of rectal anastomotic leakage occurred after operation,the incidence was 5.1%(32/628).Among them,31 patients improved after conservative treatment;1 patient underwent transverse colostomy because of senous condition,and the condition was stable after active treatment;no patient died.Univarnate analysis showed that there were 9 factors related to anastomotic leakage,including patient's sex,preoperative hemoglobin level below 110g/L,preoperative albumin level,postoperative infection,distance between tumor and anal margin,preoperative obstruction,pelvic floor peritoneal closure,intraoperative peritoneal perfusion chemotherapy and prophylactic ileostomy.After multivariate logistic regression analysis,the patients'gender(OR=8.622,95%CI:2.042-36.402,P=0.003),postoperative infection(OR=0.106,95%CI:0.022-0.516,P=0.005),distance between tumors and anal margin(OR=7.176,95%CI:2.169-23.748,P=0.001),preoperative obstruction(OR=0.176,95%CI:0.053-0.581,3 P=0.004),intraperitoneal infusion chemotherapy were obtained.(OR=0.241,95%CI:0.079-0.739,/P=0.013)5 factors were independent risk factors for anastomotic leakage.Preventive ileostomy(OR=4.265,95%CI:1.058-17.196,P=0.041)was the protective factor for anastomotic leakage.ConclusionsThe occurrence of anastomotic leakage after LAR for laparoscopic rectal cance is related to many factors.Sex,infection,distance between tumors and anal margin,preoperative obstruction and intraoperative intraperitoneal perfusion chemotherapy are independent risk factors for anastomotic leakage.Preventive ileostomy is the protective factor for anastomotic leakage.