Risk Factors Analysis of Anastomotic Fistula after Total Mesorectum Excision in Middle and Low Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 KONGJie , GANCong-cun , XUShi-jie , JIANGHai-feng

Department of Tumor Surgery, The Second People's Hospital of Chuzhou City, Chuzhou 239000, Anhui Province, China;

Corresponding author：

KONGJie, Email: kongjie04@126.com

Keywords：

Middle and low rectal cancer; Total mesorectum excision; Anastomotic fistula; Risk factor

DOI：

10.7507/1007-9424.20160054

Video：

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Objective To investigate risk factors of anastomotic fistula after total mesorectum excision (TME) in middle and low rectal cancer. Methods The clinical data of 446 patients with middle and low rectal cancer received TME surgery from June 2004 to June 2014 were retrospectively analyzed.Single-factor analysis of risk factors was used by χ² test,multiple-factor analysis was used by logistic regression analysis. Results There were 36 patients with anastomotic fistula in these 446 patients,which of 22 patients were recovered after conservative treatment,of 14 patients were recovered after colostomy.The results of single-factor analysis showed that the age>60 years,preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,distance from anasto-mosis to anus<5 cm,non-strengthen suture by hand were the risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05).The results of multiple-factor analysis showed that the preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,and distance from anastomosis to anus<5 cm were the independent risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05). Conclusions Risk of anastomotic fistula after TME in middle and low rectal cancer is higher.Basic complications of patient and local conditions of anastomosis,and intraoperative factors could affect incidence of anastomotic fistula,it should be paid enough attention.In general,most of anastomotic fistula could be cured with conservative treatment,in case of conservative treatment is invalid,colostomy is feasible.

Citation： KONGJie, GANCong-cun, XUShi-jie, JIANGHai-feng. Risk Factors Analysis of Anastomotic Fistula after Total Mesorectum Excision in Middle and Low Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 210-213. doi: 10.7507/1007-9424.20160054 Copy

1.	Evans C, Lim J, Gatzen C, et al. Factors influencing laparoscopic colorectal operative duration and its effect on clinical outcome. Surg Laparosc Endosc Percutan Tech, 2012, 22(5):437-442.
2.	Zaharie F, Mocan L, Tomus C, et al. Risk factors for anastomotic leakeage following colo-rectal resections for cancer. Chirurgia (Bucur), 2012, 107(1):27-32.
3.	Tortorelli AP, Alfieri S, Sanchez AM, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision:incid-ence, risk factors, and management. Am Surg, 2015, 81(1):41-47.
4.	Pommergaard HC, Gessler B, Burcharth J, et al. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer:a systematic review and meta-analysis. Colorectal Dis, 2014, 16(9):662-671.
5.	赵文韬, 胡丰良, 李玉英, 等. 直肠癌前切除术后吻合口瘘的危险因素分析. 中国普通外科杂志, 2012, 21(6):746-748.
6.	王新, 周建平, 张丹华, 等. 直肠癌术后发生吻合口瘘危险因素分析(附506例报告). 中国实用外科杂志, 2014, 9(9):876-879.
7.	徐园, 邵钦树, 陶厚权, 等. 直肠癌前切除术后吻合口瘘24例临床分析. 肿瘤学杂志, 2014, 20(1):55-58.
8.	戴翔, 王元杰, 赵小军, 等. 肠系膜下动脉高位结扎对直肠癌根治术后发生吻合口瘘的影响. 中国肿瘤临床与康复, 2013, 12(12):1384-1387.
9.	Bertelsen CA, Andreasen AH, Jørgensen T, et al. Anastomotic leakage after anterior resection for rectal cancer:risk factors. Colorectal Dis, 2010, 12(1):37-43.
10.	戴东, 颜文贞, 谭小宇, 等. 直肠癌低位吻合口瘘预防措施的临床探讨. 中华肿瘤防治杂志, 2008, 15(23):1832-1834.
11.	曹海生, 关利响. 中下段直肠癌行低位前切除术后吻合口瘘发生的相关因素探讨. 中国普通外科杂志, 2012, 21(10):1300-1303.
12.	陈真, 杨步荣, 代佑果, 等. 低位直肠癌双吻合器保肛术吻合口瘘原因及防治措施(附68例报告). 结直肠肛门外科, 2007, 13(5):307-309.
13.	马留学, 李景永, 王瑜, 等. 三管冲洗引流在预防直肠癌TME术后吻合口瘘中的应用. 中国普通外科杂志, 2011, 20(10):1040-1043.
14.	姚敬, 韩晓东, 汪昱. 直肠癌术后吻合口瘘的危险因素及对预后的影响. 中华普通外科杂志, 2010, 25(6):433-435.
15.	杜荣云. 低位直肠癌前切除术后吻合口瘘14例临床分析. 中华实用诊断与治疗杂志, 2012, 26(3):294-295.
16.	钟锋, 高连中, 卢一静. 直肠癌全直肠系膜切除术后吻合口瘘的影响因素分析. 中国肿瘤临床与康复, 2014, 2(2):175-177.
17.	Park JS, Choi GS, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision:the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4):665-671.

1. Evans C, Lim J, Gatzen C, et al. Factors influencing laparoscopic colorectal operative duration and its effect on clinical outcome. Surg Laparosc Endosc Percutan Tech, 2012, 22(5):437-442.
2. Zaharie F, Mocan L, Tomus C, et al. Risk factors for anastomotic leakeage following colo-rectal resections for cancer. Chirurgia (Bucur), 2012, 107(1):27-32.
3. Tortorelli AP, Alfieri S, Sanchez AM, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision:incid-ence, risk factors, and management. Am Surg, 2015, 81(1):41-47.
4. Pommergaard HC, Gessler B, Burcharth J, et al. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer:a systematic review and meta-analysis. Colorectal Dis, 2014, 16(9):662-671.
5. 赵文韬, 胡丰良, 李玉英, 等. 直肠癌前切除术后吻合口瘘的危险因素分析. 中国普通外科杂志, 2012, 21(6):746-748.
6. 王新, 周建平, 张丹华, 等. 直肠癌术后发生吻合口瘘危险因素分析(附506例报告). 中国实用外科杂志, 2014, 9(9):876-879.
7. 徐园, 邵钦树, 陶厚权, 等. 直肠癌前切除术后吻合口瘘24例临床分析. 肿瘤学杂志, 2014, 20(1):55-58.
8. 戴翔, 王元杰, 赵小军, 等. 肠系膜下动脉高位结扎对直肠癌根治术后发生吻合口瘘的影响. 中国肿瘤临床与康复, 2013, 12(12):1384-1387.
9. Bertelsen CA, Andreasen AH, Jørgensen T, et al. Anastomotic leakage after anterior resection for rectal cancer:risk factors. Colorectal Dis, 2010, 12(1):37-43.
10. 戴东, 颜文贞, 谭小宇, 等. 直肠癌低位吻合口瘘预防措施的临床探讨. 中华肿瘤防治杂志, 2008, 15(23):1832-1834.
11. 曹海生, 关利响. 中下段直肠癌行低位前切除术后吻合口瘘发生的相关因素探讨. 中国普通外科杂志, 2012, 21(10):1300-1303.
12. 陈真, 杨步荣, 代佑果, 等. 低位直肠癌双吻合器保肛术吻合口瘘原因及防治措施(附68例报告). 结直肠肛门外科, 2007, 13(5):307-309.
13. 马留学, 李景永, 王瑜, 等. 三管冲洗引流在预防直肠癌TME术后吻合口瘘中的应用. 中国普通外科杂志, 2011, 20(10):1040-1043.
14. 姚敬, 韩晓东, 汪昱. 直肠癌术后吻合口瘘的危险因素及对预后的影响. 中华普通外科杂志, 2010, 25(6):433-435.
15. 杜荣云. 低位直肠癌前切除术后吻合口瘘14例临床分析. 中华实用诊断与治疗杂志, 2012, 26(3):294-295.
16. 钟锋, 高连中, 卢一静. 直肠癌全直肠系膜切除术后吻合口瘘的影响因素分析. 中国肿瘤临床与康复, 2014, 2(2):175-177.
17. Park JS, Choi GS, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision:the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4):665-671.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk Factors Analysis of Anastomotic Fistula after Total Mesorectum Excision in Middle and Low Rectal Cancer

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