| Objective To explore the clinicopathological characteristics of obstructive rectal cancer,analyze the prognostic effect of intestinal obstruction on patients with rectal cancer,and provide basis for the pathogenesis,prevention and treatment of rectal cancer with intestinal obstruction through the diagnosis and treatment of obstructive rectal cancer.Methods The clinicopathological data and diagnosis and treatment of rectal cancer patients in the First Affiliated Hospital of Guangxi Medical University from May 2012 to December 2017 were retrospectively analyzed.Following the inclusion and exclusion criteria,78 patients in obstruction group and 78 patients in non-obstruction group were selected by stratified sampling and random number table.The follow-up deadline was 31 December 2018.SPSS22.0 was used to establish a database for descriptive analysis of data rates and constituent ratios;chi-square test or Fisher exact probability method was used for comparison of disordered qualitative variables;Kruskal Wallis H rank sum test was used for comparison of ordered qualitative variables;two independent sample t test was used for comparison of measurement data of two normal or approximate normal distributions;Kaplan-Meier method was used forsurvival prognosis analysis.The survival rates of the two groups were compared by log-rank test,and the prognostic factors were analyzed by Cox proportional hazard regression model.The test level is ?=0.05.Results 1.There were significant differences in CEA,white blood cells,percentage of neutrophils,albumin,distant metastasis,tumor location,hemoglobin and BMI between the obstruction group and the non-obstruction group before treatment.There were no significant differences in gender,age and ASA scores.There were significant differences in gross type,histological grade,perimeter of intestinal cavity occupied by tumors,T stage and N stage.There were no significant differences in histological type,vascular tumor thrombus,nerve invasion and lymph node detection.2.The median survival time was 41 months in the obstructive group,65.6% and 25.9% in the three-year and five-year survival rates,64 months in the non-obstructive group,78.8% and54.6% in the three-year and five-year survival rates.Log-rank test showed that?2= 11.497,P = 0.001 < 0.05.There was significant difference in survival curve between the two groups.3.Univariate COX proportional risk regression analysis showed that HR = 2.206(95% CI,1.375,3.539),?2 = 10.753,P= 0.001 < 0.05,with statistical significance.Multivariate COX proportional risk regression analysis showed that intestinal obstruction,pre-treatment CA199,concurrent chemoradiotherapy and TNM staging were independent prognostic factors.Among them,intestinal obstruction affected HR = 1.723(95% CI,1.043,2.846),?2= 4.508,P= 0.034 < 0.05 in rectal cancer patients.Intestinal obstruction increased the mortality risk of rectal cancer patients by 0.723 times.4.Comparisons of total surgical complications in different stages of obstruction group were ?2=3.366,P=0.361>0.05,with no significant difference.5.In the obstruction group,5 cases received neoadjuvant chemoradiotherapy and 7 casesreceived postoperative chemoradiotherapy,and the total incidence of operation-related complications was 40.0% VS 42.9%.There was no significant difference between the two groups by Fisher's exact probability method(P=1.000>0.05).The total hospitalization days related to operation were(32.20±3.27)days VS(20.86±4.06)days.The difference between the two groups was significant(t=5.147,P=0.000<0.05).The median survival time was 26 months and the total survival rate was 60.0%,while the median survival time was 46 months and the total survival rate was 57.1%.Log-rank test showed that?2= 2.066,P= 0.151 > 0.05.There was no significant difference in survival curve between the two groups.6.Three cases of obstructive rectal cancer underwent self-expanding metal stent implantation without success.Conclusions 1.Obstructive rectal cancer has higher CEA,white blood cell count and percentage of central granulocyte,lower albumin level and body mass index,and is more prone to distant metastasis and anemia.Invasive rectal cancer has a higher proportion,larger perimeter of intestinal cavity,higher proportion of poorly differentiated tumor tissue,and later T stage and N stage.2.The prognosis of rectal cancer with intestinal obstruction is poor.The 3-year and5-year survival rates in the obstructive group after resection of rectal cancer are lower than those in the non-obstructive group.3.Intestinal obstruction is an independent risk factor for poor prognosis of rectal cancer.It can reduce the overall survival time and overall survival rate of patients with rectal cancer.4.The treatment of obstructive rectal cancer is complex,and the incidence of total complications in different stages of operation is not significantly different.5.There was no significant difference in the incidence of complications and overall survival rate between the two groups.6.The efficacy of self-expanding metal stent implantation for obstructive rectal cancer needs further study.Therefore,rectal cancer should be detected,diagnosed and treated early to prevent and treat intestinal obstruction,so as to improve the prognosis. |
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