Clinical Effect Analysis Of Early Surgical Stoma For Postoperative Anastomotic Leak In Rectal Cancer

ObjectiveTo compare the efficacy of two different treatment options,surgical treatment and conservative treatment,and to evaluate the clinical effect of early surgical stoma for postoperative anastomotic leakage in rectal cancer,in the hope of providing suggestions and inspiration for clinically relevant cases.MethodsThis study was a retrospective analysis of patients with postoperative anastomotic leakage of rectal cancer admitted to the Department of Gastrointestinal Colorectal Surgery China-Japan Union Hospital of Jilin University between January 2017 and September 2022.A total of 154 patients were included in this study according to the established inclusion and exclusion criteria.According to the treatment decision grouping after the occurrence of anastomotic leakage,those who took the decision of surgical ostomy treatment within 4 8 hours after the occurrence of anastomotic leakage were classified as the early surgical ostomy group(surgical group);those who made the decision of conservative treatment after anastomotic leakage were classified as the conservative treatment group(conservative group).There were 4 6 cases in the early surgical stoma group and 10 8 cases in the conservative treatment group.The general clinical data such as gender,age,BMI,preoperative albumin level,history of alcohol and tobacco addiction,whether diabetes mellitus,and ASA classification was combined were recorded and compared.Tumor-related data such as preoperative CEA level,distance from the lower edge of the tumor to the anal verge,preoperative obstruction status,Whether neoadjuvant chemotherapy,and TNM stage of the tumor were recorded and compared.Treatment-related information such as time from postoperative to the occurrence of anastomotic leakage,days of fever due to anastomotic leakage,days of abdominal pain,duration of fasting,time with tube and whether to discharge with tube,number of imaging examinations,whether to transfer to ICU for treatment,duration of hospitalization,hospitalization cost,treatment outcome,and complications were recorded and compared.Results1.There were no statistically significant differences(P>0.05)in the general data comparing the two groups in terms of gender,age,BMI,preoperative albumin level,history of adverse tobacco and alcohol habits,history of diabetes mellitus,and ASA classification.There was no statistically significant difference(P>0.05)in the oncology date comparing the two groups in terms of preoperative CEA level,distance from the lower edge of the tumor to the anal verge,preoperative obstruction status,preoperative neoadjuvant chemotherapy,and tumor stage.2.Statistical data on the treatment outcome of patients in both groups.The mean time from surgery to the onset of anastomotic leakage was 5.8 ± 1.7 days in the surgical group and 6.4 ± 1.7 days in the conservative group;the median number of days with fever due to anastomotic leakage was 2(1,3)days in the surgical group and 7(6,9)days in the conservative group;the median number of days with abdominal pain due to anastomotic leakage was 2(2,3)days in the surgical group and 7(6,10)days in the conservative group;the median time required for the treatment of anastomotic leakage in the surgical group was 5(4,6)days and the median time required for the treatment of anastomotic leakage in the conservative group was 17.5(14,21)days.The median duration of fasting required for the treatment of anastomotic leakage was 5(4,6)days in the surgical group and 17.5(14,21)days in the conservative group;the median number of imaging examinations required for the treatment of anastomotic leakage was 1(0,1)in the surgical group and 3(2,4)in the conservative group;all 46 patients in the surgical group had their drains removed before discharge,58 patients(53.7%)in the conservative group had their drains removed before discharge,and 50 patients(46.3%)in the conservative group had their drains removed before discharge.In the conservative group,58 patients(53.7%)had their drains removed before discharge,and 50 patients(46.3%)had their drains removed before discharge;the average duration of stay was 16.1±3.7 days in the surgical group and 29.6±8.1 days in the conservative group;the average daily flow was 50.61±13.95 ml in the surgical group and 135.48±34.38 ml in the conservative group;the average duration of stay was 21.52±3.58 days in the surgical group and 33.22±9.60 days in the conservative group.All 46 patients in the surgical group had healed anastomotic leakage by surgical stoma treatment,82 patients(75.9%)in the conservative group had healed anastomotic leakage by conservative treatment,and 26 patients(24.1%)had not healed anastomotic leakage by conservative treatment;the difference between the two groups was statistically significant(P<0.05).Four patients(8.7%)in the surgical group required transfer to the ICU during treatment,and 6 patients(5.6%)in the conservative group required transfer to the ICU;there were no deaths in the surgical group,and 6 patients(5.6%)in the conservative group died;7 patients(21.9%)in the surgical group had anastomotic stenosis,and 13 patients(16.9%)in the conservative group had anastomotic stenosis;There was no statistically significant difference between the two groups(P>0.05).Conclusion1.The choice of anastomotic leak treatment needs to be careful,based on the basic treatment principles,close observation of changes in the condition and individualized treatment strategy.2.For postoperative anastomotic leak of rectal cancer without prophylactic stoma,early surgical stoma can be considered as the preferred treatment.