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.	趙文韜, 胡豐良, 李玉英, 等. 直腸癌前切除術后吻合口瘺的危險因素分析. 中國普通外科雜志, 2012, 21(6):746-748.
6.	王新, 周建平, 張丹華, 等. 直腸癌術后發生吻合口瘺危險因素分析(附506例報告). 中國實用外科雜志, 2014, 9(9):876-879.
7.	徐園, 邵欽樹, 陶厚權, 等. 直腸癌前切除術后吻合口瘺24例臨床分析. 腫瘤學雜志, 2014, 20(1):55-58.
8.	戴翔, 王元杰, 趙小軍, 等. 腸系膜下動脈高位結扎對直腸癌根治術后發生吻合口瘺的影響. 中國腫瘤臨床與康復, 2013, 12(12):1384-1387.
9.	Bertelsen CA, Andreasen AH, J?rgensen T, et al. Anastomotic leakage after anterior resection for rectal cancer:risk factors. Colorectal Dis, 2010, 12(1):37-43.
10.	戴東, 顏文貞, 譚小宇, 等. 直腸癌低位吻合口瘺預防措施的臨床探討. 中華腫瘤防治雜志, 2008, 15(23):1832-1834.
11.	曹海生, 關利響. 中下段直腸癌行低位前切除術后吻合口瘺發生的相關因素探討. 中國普通外科雜志, 2012, 21(10):1300-1303.
12.	陳真, 楊步榮, 代佑果, 等. 低位直腸癌雙吻合器保肛術吻合口瘺原因及防治措施(附68例報告). 結直腸肛門外科, 2007, 13(5):307-309.
13.	馬留學, 李景永, 王瑜, 等. 三管沖洗引流在預防直腸癌TME術后吻合口瘺中的應用. 中國普通外科雜志, 2011, 20(10):1040-1043.
14.	姚敬, 韓曉東, 汪昱. 直腸癌術后吻合口瘺的危險因素及對預后的影響. 中華普通外科雜志, 2010, 25(6):433-435.
15.	杜榮云. 低位直腸癌前切除術后吻合口瘺14例臨床分析. 中華實用診斷與治療雜志, 2012, 26(3):294-295.
16.	鐘鋒, 高連中, 盧一靜. 直腸癌全直腸系膜切除術后吻合口瘺的影響因素分析. 中國腫瘤臨床與康復, 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. 趙文韜, 胡豐良, 李玉英, 等. 直腸癌前切除術后吻合口瘺的危險因素分析. 中國普通外科雜志, 2012, 21(6):746-748.
6. 王新, 周建平, 張丹華, 等. 直腸癌術后發生吻合口瘺危險因素分析(附506例報告). 中國實用外科雜志, 2014, 9(9):876-879.
7. 徐園, 邵欽樹, 陶厚權, 等. 直腸癌前切除術后吻合口瘺24例臨床分析. 腫瘤學雜志, 2014, 20(1):55-58.
8. 戴翔, 王元杰, 趙小軍, 等. 腸系膜下動脈高位結扎對直腸癌根治術后發生吻合口瘺的影響. 中國腫瘤臨床與康復, 2013, 12(12):1384-1387.
9. Bertelsen CA, Andreasen AH, J?rgensen T, et al. Anastomotic leakage after anterior resection for rectal cancer:risk factors. Colorectal Dis, 2010, 12(1):37-43.
10. 戴東, 顏文貞, 譚小宇, 等. 直腸癌低位吻合口瘺預防措施的臨床探討. 中華腫瘤防治雜志, 2008, 15(23):1832-1834.
11. 曹海生, 關利響. 中下段直腸癌行低位前切除術后吻合口瘺發生的相關因素探討. 中國普通外科雜志, 2012, 21(10):1300-1303.
12. 陳真, 楊步榮, 代佑果, 等. 低位直腸癌雙吻合器保肛術吻合口瘺原因及防治措施(附68例報告). 結直腸肛門外科, 2007, 13(5):307-309.
13. 馬留學, 李景永, 王瑜, 等. 三管沖洗引流在預防直腸癌TME術后吻合口瘺中的應用. 中國普通外科雜志, 2011, 20(10):1040-1043.
14. 姚敬, 韓曉東, 汪昱. 直腸癌術后吻合口瘺的危險因素及對預后的影響. 中華普通外科雜志, 2010, 25(6):433-435.
15. 杜榮云. 低位直腸癌前切除術后吻合口瘺14例臨床分析. 中華實用診斷與治療雜志, 2012, 26(3):294-295.
16. 鐘鋒, 高連中, 盧一靜. 直腸癌全直腸系膜切除術后吻合口瘺的影響因素分析. 中國腫瘤臨床與康復, 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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