Meta-analysis And Trial Sequential Analysis Of Risk Factors Of Anastomotic Leakage After Resection Of Rectal Cancer

Objective:To study the risk factors of anastomotic leakage within 30 days after surgical resection of rectal cancer,so as to provide theoretical basis for reducing the occurrence of anastomotic leakage and guide clinical practice.Methods:Studies on risk factors of anastomotic leakage after resection of rectal cancer was retrieved online by computer.CNKI and Wanfang databases were searched in Chinese.Embase,Pubmed and Cochrane Library databases were searched in English.Retrieval time ranged from built of databases to October 2018.Two researchers independently screened the literature and scored the quality,confirmed the included literature together with the third person,extracted the data and performed Meta-analysis by Review Manager(Version 5.3.3)statistical software,then used the Trial Sequential Analysis sof-tware[TSA Viewer(Version 0.9.5.10 Beta)]to conduct risk control of repeated significance test and sample size assessment on risk factors.Result:A total of 71 literature were included,the relationships between postoperative anastomotic leakage of rectal cancer and risk factors was studied through Meta-analysis and Trial Sequential Analysis.The results were as follows:Open surgery[OR 1.35(95%CI:1.11～1.63);P=0.003],Male[OR 1.75(95%CI:1.58～1.93);P<0.00001],history of diabetes[OR 1.98(95%CI:1.62～2.42);P<0.00001],preoperative chemoradiotherapy[OR 1.98(95%CI:1.53～2.57);P<0.00001],the height of the tumor within 7cm from the anal edge[OR 2.73(95%CI:2.05～3.63);P=0.00001],are risk factors of anastomotic leakage after resection of rectal cancer,TSA indicates that these results are reliable.High ligation of IMA[OR 1.02(95%CI:0.82～1.26);P=1.00],is not the risk factor of anastomotic leakage after resection of rectal cancer,TSA indicates this result is reliable.Diverting stoma[OR 0.56(95%CI:0.43～0.74);P<0.00001]can reduce the incidence of anastomotic leakages,TSA indicates that these results are reliable.The anastomosis within 4cm from the anal edge[OR2.89(95%CI:1.52～2.49);P=0.001],low albumin{Alb<35g/L[OR 2.42(95%CI:1.30～4.50);P=0.006];Alb≤30g/L[OR 6.88(95%CI:2.16～21.91);P=0.001]},are risk factors of anastomotic leakage after resection of rectal cancer,TSA indicates that large sample research is needed Pelvic drainage[OR 0.73(95%CI:0.29～1.82);P=0.5],ages{60 years old[OR 1.12(95%CI:0.83～1.52);P=0.45];65 years old[OR 1.23(95%CI:0.86～1.76);P=0.25];70 years old[OR 1.31(95%CI:0.98～1.76);P=0.07]},aren’t risk factors of anastomotic leakage after resection of rectal cancer,TSA indicates that large sample research is needed Conclusion:Open surgery,male,history of diabetes,preoperative chemoradiotherapy,tumor height within 7cm from anal edge are certain risk factors for postoperative anastomotic leakage of rectal cancer.The high tie of IMA is not a risk factor for anastomotic leakage.The application of diverting stoma can reduce the incidence of anastomotic fistula.Adjusted significance test in the cumulative meta-analysis has measured the strength of the available evidence and controlled for statistical errors,clinical results are reliable.The anastomosis within 4cm from the anal edge,low albumin are risk factors of anastomotic leakage after resection of rectal cancer;Pelvic drainage,ages,application of NSAIDs aren’t risk factors of anastomotic leakage after resection of rectal cancer,TSA indicates that the exact evidence need supports of large sample researches,results only for clinical reference.