Abstract: Objective;To investigate the influencing factors for anastomotic leakage after transabdominal transanal total mesorectal excision.
Methods:The retrospective case-control study was conducted. The clinicopathological data of 50 patients with rectal cancer who were admitted to the Renji Hospital of Shanghai Jiaotong University School of Medicine from December 2017 to November 2018 were collected. There were 34 males and 16 females, aged (60±11)years, with a range from 31 to 84 years. All the patients underwent transabdominal transanal total mesorectal excision. Observation indicators: (1) anastomotic leakage after transabdominal transanal total mesorectal excision; (2) analysis of influencing factors for anastomotic leakage after transabdominal transanal total mesorectal excision; (3) effects of learning curve on anastomotic leakage after transabdominal transanal total mesorectal excision. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages. Univariate analysis was conducted using the chi-square test, and multivariate analysis was conducted using the Logistic regression model.
Results:(1) Anastomotic leakage after transabdominal transanal total mesorectal excision: of the 50 patients, 9 had postoperative anastomotic leakage, including 6 of grade A anastomotic leakage (2 patients receiving protective enterostomy), 2 of grade B anastomotic leakage, and 1 of grade C anastomotic leakage. Of the 9 patients with anastomotic leakage, there were 5 males and 4 females, aged 62 years (range, 40-75 years). The 9 patients had a body mass index of 27 kg/m² (range, 21-31 kg/m²), and a distance from anastomosis to anal edge of 30 mm (range, 5-40 mm). (2) Analysis of influencing factors for anastomotic leakage after transabdominal transanal total mesorectal excision: results of univariate analysis showed that anastomotic method and protective stoma were related factors for anastomotic leakage after transabdominal transanal total mesorectal excision (x²=5.490, 5.456, P<0.05). Results of multivariate analysis showed that anastomotic method and protective stoma were not independent factors for anastomotic leakage after transabdominal transanal total mesorectal excision (odds ratio=0.062, 0.460, 95% confidence interval: 0.009-1.119, 0.102-2.809, P>0.05). (3) Effects of learning curve on anastomotic leakage after transabdominal transanal total mesorectal excision: with the passing of learning curve and the use of protective stoma, 11 of the first 25 patients of learning cure underwent protective stoma and 6 had postoperative anastomotic leakage, while 20 of the last 25 patients of learning cure underwent protective stoma and 3 had postoperative anastomotic leakage. There was no significant difference in the postoperative anastomotic leakage between them (x²=1.220, P>0.05).
Conclusion:Anastomotic method and protective stoma are related factors influencing anastomotic leakage after transabdominal transanal total mesorectal excision.