Risk factors for anastomotic leakage after radical colorectal cancer surgery and its impact on prognosis: Clinical education research

Table 1 Comparison of Baseline Characteristics Between AL and Non-AL Groups, n (%)/mean ± SD/mean (interquartile range)

Variable	AL group (n = 22)	Non-AL group (n = 178)	χ²/t/Z value	P value
Gender			0.286	0.593
Male	14 (63.6)	102 (57.3)
Female	8 (36.4)	76 (42.7)
Age (years)	63.2 ± 9.8	61.4 ± 10.6	0.771	0.442
BMI (kg/m²)	26.2 ± 3.6	23.8 ± 3.2	3.478	0.001
Smoking history	10 (45.5)	58 (32.6)	1.476	0.224
Drinking history	8 (36.4)	50 (28.1)	0.624	0.430
Diabetes mellitus	8 (36.4)	24 (13.5)	7.552	0.006
Hypertension	9 (40.9)	58 (32.6)	0.573	0.449
ASA grade			4.286	0.038
I-II	10 (45.5)	118 (66.3)
III-IV	12 (54.5)	60 (33.7)
Tumor location			5.243	0.022
Colon	7 (31.8)	94 (52.8)
Rectum	15 (68.2)	84 (47.2)
TNM staging			1.028	0.598
Stage I	4 (18.2)	42 (23.6)
Stage II	9 (40.9)	72 (40.4)
Stage III	9 (40.9)	64 (36.0)
Neoadjuvant therapy	8 (36.4)	38 (21.3)	2.512	0.043
Protective stoma	4 (18.2)	56 (31.5)	1.640	0.037
Preop albumin < 35 g/L	9 (40.9)	34 (19.1)	5.468	0.019
Operation time (minutes)	204.2 ± 46.5	174.8 ± 40.2	3.227	0.002
Intraop blood loss (mL)	250 (150-400)	150 (100-230)	-3.142	0.002

AL: Anastomotic leakage; BMI: Body mass index; ASA: American Society of Anesthesiologists.

Table 2 Univariate logistic regression analysis of risk factors for anastomotic leakage

Variable	OR	95%CI	Wald χ²	P value
Age (≥ 65 years vs < 65 years)	1.248	0.632-2.464	0.538	0.463
Gender (male vs female)	1.136	0.562-2.296	0.102	0.749
BMI (≥ 25 kg/m² vs < 25 kg/m²)	2.762	1.268-6.016	6.872	0.009
Diabetes mellitus (yes vs no)	2.824	1.342-5.938	8.124	0.004
Hypertension (yes vs no)	1.384	0.682-2.810	0.824	0.364
Smoking (yes vs no)	1.678	0.802-3.512	1.896	0.168
ASA grade III-IV vs I-II	2.384	1.062-5.354	4.528	0.033
Tumor location (rectum vs colon)	2.402	1.046-5.516	4.286	0.038
TNM stage III vs I-II	1.288	0.582-2.852	0.484	0.487
Neoadjuvant therapy (yes vs no)	2.152	0.928-4.994	3.162	0.075
Protective stoma (yes vs no)	0.468	0.166-1.322	2.286	0.043
Preop albumin < 35 g/L (yes vs no)	2.826	1.224-6.522	6.172	0.013
Operation time ≥ 180 minutes (yes vs no)	2.648	1.164-6.022	5.528	0.019
Intraop blood loss ≥ 200 mL (yes vs no)	2.284	1.006-5.186	3.928	0.048

BMI: Body mass index; ASA: American Society of Anesthesiologists; OR: Odds ratio.

Table 3 Multivariate logistic regression analysis of independent risk factors for anastomotic leakage

Variable	β	SE	Wald χ²	OR	95%CI	P value
BMI ≥ 25 kg/m²	0.856	0.346	6.124	2.354	1.196-4.632	0.013
Diabetes mellitus	0.978	0.382	6.556	2.660	1.258-5.624	0.010
Tumor location (rectum)	0.892	0.362	6.084	2.440	1.198-4.970	0.014
Neoadjuvant therapy	0.782	0.378	4.282	2.186	1.042-4.584	0.039
Preop albumin < 35 g/L	0.986	0.378	6.804	2.680	1.278-5.620	0.009
Operation time ≥ 180 minutes	0.848	0.364	5.424	2.334	1.142-4.770	0.020
Intraop blood loss ≥ 200 mL	0.762	0.376	4.108	2.142	1.024-4.482	0.043
Protective stoma	-0.908	0.428	4.498	0.403	0.174-0.932	0.034

BMI: Body mass index; OR: Odds ratio.

Table 4 Clinical grade, manifestations, and management of anastomotic leakage cases (n = 22), n (%)/mean ± SD/mean (interquartile range)

Characteristic	Grade A (n = 8)	Grade B (n = 10)	Grade C (n = 4)	Total (n = 22)	P value
Onset time (days)	6 (4-9)	8 (5-12)	5 (3-7)	7 (4-11)	0.312
Clinical manifestations
Fever	4 (50.0)	7 (70.0)	4 (100.0)	15 (68.2)	0.046
Abdominal pain	2 (25.0)	7 (70.0)	4 (100.0)	13 (59.1)	0.004
Feculent drainage	1 (12.5)	6 (60.0)	4 (100.0)	11 (50.0)	0.002
Peritonitis signs	0 (0.0)	2 (20.0)	4 (100.0)	6 (27.3)	0.001
Management
Conservative treatment	8 (100.0)	4 (40.0)	0 (0.0)	12 (54.5)	< 0.001
Interventional drainage	0 (0.0)	4 (40.0)	2 (50.0)	6 (27.3)	< 0.001
Surgical re-intervention	0 (0.0)	2 (20.0)	2 (50.0)	4 (18.2)	< 0.001
ICU admission	0 (0.0)	2 (20.0)	3 (75.0)	5 (22.7)	< 0.001
Hospital stay (days)	13.6 ± 3.4	25.8 ± 7.2	40.4 ± 13.8	24.2 ± 12.4	< 0.001
30-day mortality	0 (0.0)	0 (0.0)	1 (25.0)	1 (4.5)	0.021

ICU: Intensive care unit.

Table 5 Comparison of short-term postoperative outcomes between anastomotic leakage and non-anastomotic leakage groups, n (%)/mean ± SD

Outcome indicator	AL group (n = 22)	Non-AL group (n = 178)	χ²/t/Z	P value
Hospital stay (days)	24.2 ± 12.4	10.8 ± 4.2	7.268	< 0.001
Postop hospital stay (days)	19.6 ± 10.8	7.8 ± 3.4	6.924	< 0.001
Time to first flatus (days)	5.4 ± 1.8	3.6 ± 1.2	4.428	< 0.001
Time to oral feeding (days)	7.6 ± 2.8	4.4 ± 1.6	5.124	< 0.001
Overall complication rate	18 (81.8)	40 (22.5)	34.284	< 0.001
Wound infection	6 (27.3)	14 (7.9)	8.214	0.004
Abdominal abscess	5 (22.7)	8 (4.5)	11.246	0.001
Intestinal obstruction	4 (18.2)	10 (5.6)	4.428	0.035
Urinary tract infection	3 (13.6)	12 (6.7)	1.286	0.257
Pulmonary complications	4 (18.2)	16 (9.0)	1.680	0.195
Reoperation rate	4 (18.2)	6 (3.4)	7.354	0.007
30-day mortality	1 (4.5)	1 (0.6)	Fisher: 0.042	0.042
Permanent stoma rate	12 (54.5)	24 (13.5)	16.948	< 0.001
Adjuvant chemo delay	10 (45.5)	20 (11.2)	14.286	< 0.001

AL: Anastomotic leakage.

Table 6 Cox regression analysis of factors affecting disease-free survival

Variable	Univariate HR	Univariate 95%CI	Univariate P value	Multivariate HR	Multivariate 95%CI	Multivariate P value
Age (≥ 65 years vs < 65 years)	1.264	0.802-1.992	0.246	-	-	-
Gender (male vs female)	1.128	0.724-1.758	0.558	-	-	-
BMI (≥ 25 kg/m² vs < 25 kg/m²)	1.248	0.802-1.942	0.278	-	-	-
TNM stage III vs I-II	2.624	1.786-3.854	< 0.001	2.248	1.526-3.312	< 0.001
Poor differentiation	1.924	1.286-2.878	0.001	1.686	1.118-2.544	0.013
Vascular invasion	2.024	1.368-2.994	< 0.001	1.782	1.188-2.672	0.005
Anastomotic leakage (yes vs no)	2.462	1.586-3.822	< 0.001	2.048	1.312-3.198	0.002
Adjuvant chemo delay (yes vs no)	1.824	1.186-2.806	0.006	1.624	1.048-2.518	0.030
Preop albumin < 35 g/L	1.624	1.028-2.564	0.038	-	-	-
Tumor location (rectum vs colon)	1.248	0.842-1.848	0.268	-	-	-

BMI: Body mass index; HR: Hazard ratio.