Severity Grading,Risk Factors,and Prediction Model Of Complications After Intersphincteric Resection For Low Rectal Cancer

Objective:The study aimed to apply the Clavien-Dindo scoring system to grade the postoperative complications of low rectal cancer patients who underwent intersphincteric resection(ISR),to analyze the risk factors associated with these complications,to construct a nomogram prediction model based on these factors,and to compare and evaluate the performance of this model.Methods:The study retrospectively analyzed the clinical data of 103 patients with low rectal cancer who underwent intersphincteric resection(ISR)at the General Surgery Department of Shaanxi Provincial People’s Hospital from January 2016 to December 2022.The researchers used univariate and multivariate logistic regression to identify the risk factors associated with postoperative complications after ISR and developed a nomogram prediction model.They validated the model using calibration curve,Hosmer-Lemeshow test,bootstrap resampling,receiver operating characteristic curve,decision curve analysis and clinical impact curve.Results:The study included 103 patients,of whom 30(29.1%)had postoperative complications.These were 16 cases of grade II,13 cases of grade III,and one case of grade IV Clavien-Dindo complications.Univariate analysis revealed that postoperative complications were associated with gender,white blood cell count,albumin level,neutrophil-to-lymphocyte ratio,diabetes mellitus,neoadjuvant chemoradiotherapy,operation time,number of metastatic lymph nodes,time to oral intake and length of hospital stay(all P<0.05).Multivariate regression analysis identified male gender(OR12.682,95%CI:2.086～77.087),preoperative white blood cell count≥6.9×10~9/L(OR5.057,95%CI:1.293～19.783),low albumin level(OR 0.652,95%CI:0.486～0.874),diabetes mellitus(OR 4.665,95%CI:1.119～19.451),neoadjuvant chemoradiotherapy(OR 8.91,95%CI:1.959～40.52)and long operation time(OR 1.017,95%CI:1.001～1.035)as independent factors affecting ISR complications.Based on these results,we constructed a nomogram prediction model with an area under the ROC curve of 0.921(95%CI:0.871～0.971).The model had a consistency index(C-index)of 0.921 in internal validation.Conclusion:Postoperative complications for low rectal cancer patients undergoing ISR are independently influenced by male sex,preoperative white blood cell count≥6.9×10~9/L,low albumin level,diabetes mellitus,neoadjuvant chemotherapy and longer operation time.A nomogram based on these factors has been developed that can accurately predict the postoperative complication risk of ISR for low rectal cancer patients.This nomogram has high practical value for clinical decision-making.