ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
ObjectiveTo compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. MethodsMedline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. ResultsA total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. ConclusionMechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.
ObjectiveTo investigate the risk factor for restenosis of esophageal anastomosis stricture after esophageal cancer operation. MethodsWe retrospectively analyzed the clinical data of 83 patients including 61males and 22 females at age of 58.9(41-81) years with esophageal anastomoic stricture after esophageal cancer operation between January 2002 and December 2013. According to whether the patients developed to restenosis or not, the statistical test and logistic regression was conducted to analyze the risk factors for restenosis. ResultsIn the 83 patients with esophageal anastomoic stricture after esophageal cancer surgery, 35 patients (42.2%) experienced restenosis within the following-up of 1 year. The result of logistic regression analysis indicated that restenosis appeared in 3 months (Wald value=23.3, P < 0.001), the interval between two subsequent sessions of more than 4 weeks at each esophagus dilatation(Wald value=4.8, P=0.029) and the stricture diameter of less than 12 mm after dilation (Wald value=5.8, P=0.016) are the independent risk factors for restenosis in esophageal anastomotic stricture. ConclusionFor the patients with esophageal anastomoic stricture after esophageal cancer operation, we believe that it's conducive to reduce esophageal restenosis if the interval between dilations is within 4 weeks and the diameter of stricture after dilation can reach above 12 mm.
Objective To investigate the correlation between end-to-side anastomotic angle and postoperative anastomotic stricture in the surgery of esophageal carcinoma. Methods From January 2011 to June 2015, 130 patients with middle/lower esophageal carcinoma or gastric cardia cancer underwent operations in Shanghai Pudong Hospital and Lishui Central Hospital, Zhejiang Province. Depending on the end-to-side anastomotic angle, they were randomly divided into two groups (n=65 in each): a 0 degree group (49 males and 16 females, aged 64.5±8.3 years) and a 45 degrees group (52 males, 13 females, aged 61.7±9.1 years). Stooler degree grading was adopted to evaluate the anastomotic stricture in each group 6 months postoperatively. Results There were two patients with anastomotic fistula in each group (P>0.05). Pathology showed squamous carcinoma in 116 patients and adenocarcinoma in 14 patients. The postoperative esophageal stricture in the 45 degrees group was significantly less than that in the 0 degree group. There was no statistical difference in the duration of chest tube (5.9±6.7 dvs. 5.8±6.8 d) and recovery of intestinal peristalsis (2.6±0.8 d vs.2.6±0.7 d) between the 45 degrees group and the 0 degree group. Conclusion Esophagogastric anastomotic angle is related to the formation of postoperative anastomotic stricture. Oblique anastomosis with 45 degrees is helpful to decrease the severity of stricture.