Influencing Factors Of Anastomotic Leakage After Anterior Resection In Patient With Rectal Cancer

ObjectiveTo explore the independent risk factors for anastomotic leakage after anterior resection of rectal cancer and establish an anastomotic leakage risk prediction model.Then,using decision curve analysis to compare it with traditional empirical models,find the optimal model to guide the intraoperative decision on defunctioning stoma,minimize unnecessary defunctioning stomas.MethodsRetrospectively collected the clinical data of 404 patients undergoing rectal resection in the First Affiliated Hospital of Anhui Medical University during October 2017 to December 2019.Firstly,we screened the effective variables by x~2 test and lasso analysis,picked independent influence factors by logistic regression analysis,then used R（4.0.5）to establish a predictive model and draw a nomogram.After that,we established decision models based respectively on diabetes,preoperative radiotherapy and chemotherapy,hemoglobin,albumin,the distance from the tumor to the anus,and the prediction model of this study.Finally,a decision curve was drawn through R（4.0.5）.Compared those models on the level of net benefit in a different threshold range.ResultsMale（OR value 4.490,95% CI: 1.491～13.518）,blood transfusion（OR value 5.822,95% CI: 1.939～17.475）and the distance between the tumor and the anal margin ≤ 7cm（OR value 2.385,95% CI: 1.086～5.237）are independent risk factors for anastomotic leakage,and mechanical bowel preparation is an independent protective factor（OR value 0.360,95% CI: 0.165～0.785）.The concordance index of the prediction model is0.735.The area under the receiver operating characteristic curve is 0.755.Our model is optimal within the threshold range of 0.05 to 1.00,and the net benefit rate is 1% to 6%.ConclusionsMale,blood transfusion,the distance between the tumor and the anal margin ≤ 7 cm,and without mechanical bowel preparation are independent risk factors for anastomotic leakage after rectal resection.Our prediction model is well discriminated and accurate,and is superior to other traditional empirical models in terms of guiding the intraoperative decision on defunctioning stoma within the threshold range of 0.1～0.2,can also achieve the highest clinical benefit.That is to say,using our predictive model to guide intraoperative stoma decision-making is reasonable.