局部进展期直肠癌新辅助放化疗联合根治术后预防性肠造口永久化的影响因素分析

Influencing factors for permanent protective stoma in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy and radical resection

    摘要
  • 摘要:
    目的 探讨局部进展期直肠癌新辅助放化疗联合根治术后预防性肠造口永久化的影响因素。
    方法 采用回顾性病例对照研究方法。收集2019年6月至2022年5月北京协和医院收治的216例局部进展期直肠癌患者的临床病理资料；男144例,女72例；年龄为60（53,68）岁。患者均接受新辅助放化疗联合根治术,行预防性肠造口。观察指标：（1）新辅助放化疗联合根治术后预防性肠造口永久化和吻合口相关并发症发生情况。（2）新辅助放化疗联合根治术后预防性肠造口永久化的影响因素分析。（3）新辅助放化疗联合根治术后吻合口相关并发症的影响因素分析。正态分布的计量资料组间比较采用独立样本t检验。偏态分布的计量资料组间比较采用Mann‑Whitney U检验。计数资料组间比较采用χ2检验或Fisher确切概率法。单因素分析根据数据类型采用对应的统计学方法。筛选单因素分析中P<0.15的指标纳入二元logistic回归行多因素分析,采用基于最大似然估计的向前逐步回归法。
    结果 （1）新辅助放化疗联合根治术后预防性肠造口永久化和吻合口相关并发症发生情况。216例患者随访时间为40（23,51）个月。216例患者中,36例发生预防性肠造口永久化,其中24例术前评估无法行造口还纳,12例还纳术后因并发症再次行肠造口术,均为横结肠造口。216例患者中,25例发生吻合口相关并发症。（2）新辅助放化疗联合根治术后预防性肠造口永久化的影响因素分析。多因素分析结果显示：吻合口相关并发症是局部进展期直肠癌新辅助放化疗联合根治术后预防性肠造口永久化的独立危险因素（优势比=17.503,95%可信区间为6.097~50.244,P<0.05）。（3）新辅助放化疗联合根治术后吻合口相关并发症的影响因素分析。多因素分析结果显示：年龄≤50岁、体质量指数低、手术时间长均是局部进展期直肠癌新辅助放化疗联合根治术后吻合口相关并发症的独立危险因素（优势比=0.385、0.770、1.105,95%可信区间为0.151~0.979、0.654~0.907、1.007~1.023,P<0.05）。
    结论 吻合口相关并发症是局部进展期直肠癌新辅助放化疗联合根治术后预防性肠造口永久化的独立危险因素。年龄≤50岁、体质量指数低、手术时间长是局部进展期直肠癌新辅助放化疗联合根治术后吻合口相关并发症的独立危险因素。

     

    Abstract:
    Objective To investigate the influencing factors for permanent protective stoma in locally advanced rectal cancer (LARC) patients after neoadjuvant chemoradiotherapy (nCRT) and radical resection.
    Methods The retrospective case‑control study was conducted. The clinicopatho-logical data of 216 patients with LARC who were admitted to Peking Union Medical College Hospital from June 2019 to May 2022 were collected. There were 144 males and 72 females, aged 60(53,68)years. All patients underwent nCRT followed by radical resection and protective stoma. Observation indicators: (1) permanent protective stoma and anastomotic complications after nCRT and radical resection; (2) influencing factors for permanent protective stoma after nCRT and radical resection; (3) influencing factors for anastomotic complications after nCRT and radical resection. Comparison of measurement data with normal distribution between groups was performed using the independent sample t test. Comparison of measurement data with skewed distribution between groups was performed using the Mann‑Whitney U rank sum test. Comparison of count data between groups was performed using the chi‑square test or Fisher exact probability. Univariate analysis was conducted using appropriate statistical methods based on the data type. Factors with P<0.15 in univariate analysis were included in binary Logistic regression for multivariate analysis using a forward stepwise method based on maximum likelihood estimation.
    Results (1) Permanent protective stoma and anastomotic complications after nCRT and radical resection. All the 216 patients were followed up of 40(23,51)months. Of the 216 patients, 36 cases developed permanent protective stoma, of which 24 cases could not have stoma reversal based on preoperative evaluation, while 12 cases required re‑colostomy with transverse colostomy after complications from reversal surgery. Of the 216 patients, 25 cases deve-loped anastomotic‑related complications. (2) Influencing factors for permanent protective stoma after nCRT and radical resection. Results of multivariate analysis showed that anastomotic‑related complication was an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection (odd ratio=17.503, 95% confidence interval as 6.097-50.244, P<0.05). (3) Influencing factors for anastomotic complications after nCRT and radical resection. Results of multivariate analysis showed that age ≤50 years, low body mass index, prolonged operation time were all independent risk factors for anastomotic-related complications in LARC patients after nCRT and radical resection(odd ratio=0.385, 0.770, 1.105, 95% confidence interval as 0.151-0.979, 0.654-0.907, 1.007-1.023, P<0.05).
    Conclusions Anastomotic-related complication is an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection. Age ≤50 years, low body mass index, prolonged operation time are independent risk factors for anastomotic-related complications in LARC after nCRT and radical resection.

     

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