Study Of Risk Factors For The Occurrence Of Postoperative Anastomotic Leak After Neoadjuvant Radiotherapy For Locally Advanced Middle And Low Rectal Cancer

Objectives:To investigate the risk factors for the occurrence of anastomotic leakage AL after neoadjuvant chemoradio therapy(NCRT)for locally advanced middle and low rectal cancer(LAMLRC).A study of risk factors for the occurrence of anastomotic leakage AL.Methods:A retrospective case-control study method was used.All patients underwent laparoscopic radical resection of rectal cancer after neoadjuvant radiotherapy,and all tumor patients underwent radical resection + anal preservation surgery according to the principle of total rectal mesorectal resection.The anastomotic leak was counted according to the follow-up within 30 days after surgery.18 patients with anastomotic leak were included in the anastomotic leak group,and 90 patients without anastomotic leak were included in the no-anastomotic leak group.The clinical data of patients in the postoperative anastomotic leak group and the no-anastomotic leak group were analyzed by one-way(P < 0.05 for statistically significant difference)and multi-factor logistics regression analysis(P < 0.05 for statistically significant difference);to investigate the risk factors for the occurrence of anastomotic leak after neoadjuvant radiotherapy for locally advanced middle and low rectal cancer.Results:The overall postoperative incidence of anastomotic leak in patients with locally advanced middle and low rectal cancer after neoadjuvant radiotherapy who underwent laparoscopic radical rectal cancer surgery + anus preservation was 16.67%.By univariate analysis,the occurrence of anastomotic leak was found to be associated with male,BMI,neoadjuvant radiotherapy with surgical interval,preoperative albumin,tumor distance from the anus,preservation of the left colonic artery,and prophylactic stoma(all P < 0.05).Patient age,ASA(American Society of Anesthesiologists)classification,smoking,diabetes,tumor growth pattern,tumor staging,tumor differentiation,nerve invasion,lateral lymph node dissection,operative time,and operative bleeding were not associated with anastomotic leak(all P > 0.05).Further multifactorial analysis by logistic regression revealed that preoperative albumin <35g/L and anastomotic distance from the anal verge ≤5 cm were independent risk factors for anastomotic leakage after neoadjuvant radiotherapy for locally advanced middle and low rectal cancer,respectively;prophylactic stoma and preservation of the left colonic artery were protective factors.Conclusion:(1)Male,BMI,neoadjuvant radiotherapy was associated with the time interval between procedures,preoperative albumin,tumor distance from the anus,preservation of the left colonic artery,and prophylactic stoma with the occurrence of postoperative anastomotic leak after neoadjuvant radiotherapy for locally advanced middle and low rectal cancer.(2)Hypoalbuminemia and tumor distance from the anus ≤5 cm were independent risk factors for the occurrence of anastomotic leak after neoadjuvant radiotherapy for locally advanced middle and low rectal surgery,respectively;prophylactic stoma and preservation of the left colonic artery were protective factors for them.