Predictive Analysis of Risk Factors for Postoperative Anastomotic Leakage After Rectal Cancer Surgery

WANG Huijun; QIAO Li'na; JIN Xianzhen; CHEN Ni; QIU Guanglin

doi:10.13730/j.issn.2097-2148.2024.06.007

Abstract：Objective To determine the risk factors of postoperative anastomotic leakage(AL)by considering the preoperative and postoperative factors in patients with rectal cancer,and to construct a nomogram model for the effective prediction of AL after surgery.Methods A single-center retrospective study was performed on 188 patients who under-went rectal cancer surgery in author's hospital from January 2018 to May 2023.The patients were divided into AL group(n=21)and non-AL group(n=167)according to the occurrence of AL.The risk factors of AL after rectal cancer sur-gery were analyzed by Logistic regression analysis,and the predictive model of AL nomogram after rectal cancer surgery was established.the predictive performance of the nomogram model was evaluated by the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results Compared with the patients in non-AL group,the patients in AL group had a higher proportion of alcohol consumption history,preoperative intestinal obstruction,pTNM stage Ⅲ/Ⅳ,lower proportion of preventive stomy and higher early postoperative pain(numeric rating scale,NRS)(all P＜0.05).Logistic regression analysis showed that preoperative intestinal obstruction and early postoperative NRS were independent risk factors for postoperative AL in rectal cancer patients,while left colic artery preservation and preventive stomy were protective factors for postoperative AL in rectal cancer patients(P＜0.05).Evaluation of the nomogram predictive model showed that the AUC of the ROC curve was 0.910(95％CI:0.853-0.968,P＜0.001),when the best predictive cut-off value was 0.303,the specificity was 95.82％and the sensitivity was 66.71％.Conclusion Retaining left colic artery and preventive stomy surgery,preoperative intestinal obstruction and early moderate to severe postoperative pain have good predictive effects on postoperative AL in patients with rectal cancer.