Clinical Investigation For Anastomotic Leakage After 358 Preserving Anal Sphincter Operation For Rectal Cancer

Objective to identify the risk and prevention of anastomotic leakage after preserving anal sphincter operation for rectal cancer.Methods A retrospective study of 358 patients received rectal cancer Dixon surgery,made Logistic regression analysis to to identify the risk of anastomotic leakage and the value of selective preventive stoma after preserving anal sphincter operation for rectal cancer.Results 358 patients received operation of preserving anal sphincter,33(9.2% 33/358) patients had an anastomotic leakage. Univariate analysis show that age≥60,obstruction,diabetes, a distance less than 7cm from the tumor to the anal edge,male, TNM≥Ⅲa were the risk factor after preserving anal sphincter operation for rectal cancer。 Performed a selective stoma is a protective factor for anastomotic leakage (P<0.10).The anemia,a low albumin level,neoadjuvant therapy were not the risk factor after preserving anal sphincter operation for rectal cancer.Multivariate analysis show that age≥60 (OR:2.650、95%CI: 1.082-6.493),obstruction (OR:6.133.95%CI:1.912-19.674), a distance less than 7cm from the tumor to the anal edge (OR:6.765.95%CI: 2.511-18.226),male (OR:7.244.95%CI:2.631-19.947), TNM≥Ⅲa (OR: 3.824、95%CI:1.605-9.110) were independent risk factor after preserving anal sphincter operation for rectal cancer.Performed a selective stoma is a protective factor for anastomotic leakage(P<0.05).The factor which had statistically were used to build Logistic regression model, Logit P=-5.855+2.650×age+ 7.244xgender+6.765×location+3.824×TNM stage+6.133×obstruction, and AUC was 0.778.When cut-off value was 0.39,the sensitivity was 66.7%,specificity was 77.0%,and the accuracy was 75.8%.Conclusion:Male,age≥60, obstruction,TNM≥Ⅲdiabetes, a distance less than 7cm from the tumor to the anal edge were the risk factor after preserving anal sphincter operation for rectal cancer.Male,age≥60, obstruction,TNM≥Ⅲa, a distance less than 7cm from the tumor to the anal edge were the independent risk factor.Performed a selective stoma is a protective factor for anastomotic leakage.