ObjectiveTo systematically summarize the research progress in risk prediction models for postoperative anastomotic leakage in gastric cancer, and to explore the advantages and limitations of models constructed using traditional statistical methods and machine learning, thereby providing a theoretical basis for clinical precision prediction and early intervention. MethodBy analyzing domestic and international literature, the construction strategies of logistic regression, least absolute shrinkage and selection operator (LASSO) regression, and machine learning models (support vector machine, random forest, deep learning) were systematically reviewed, and their predictive performance and clinical applicability were compared. ResultsThe traditional logistic regression and LASSO regression models performed excellently in terms of interpretability and in small-sample scenarios but were limited by linear assumptions. The machine learning models significantly enhanced predictive capabilities for complex data through non-linear modeling and automatic feature extraction, but required larger data scales and had higher demands for interpretability. ConclusionsDifferent prediction models have their own advantages and limitations; in practical clinical applications, they should be flexibly selected or complementarily applied based on specific scenarios. Current anastomotic leakage prediction models are evolving from single factor analysis to multi-modal dynamic integration. Future efforts should combine artificial intelligence and multi-center prospective clinical studies to validate, so advancing the development of precise and individualized anastomotic leakage predictive tools for patients after gastric cancer resection.
Objective To study feasibility of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following radical resection of rectal cancer. Method The clinical data of 11 patients with rectal cancer underwent the Dixon plus sheath technique with seromuscular sleeve of pedicled colon from January 2017 to October 2017 in the PLA Navy Anqing Hospital were analyzed. Results All the operations were completed successfully in the 11 patients with rectal cancer, including 9 cases of laparoscopy and 2 cases of laparotomy. The operative time was (255.5±51.5) min, the intraoperative bleeding was (80.0±28.3) mL, the first postoperative anal exhaust time was (4.4±2.0) d, the postoperative hospitalization time was (16.0±3.1) d. For the postoperative pathology, there were 5 cases of T4 stage, 2 cases of T3 stage, 2 cases of T2 stage, and 2 cases of T1 stage. The number of lymph node dissection was 5–23 with an average of 12.5 per case, 7 cases with lymph node metastasis. One case of lymphatic leakage and 1 case of incision infection occurred, and no anastomotic leakage and narrow occurred. After 3–10 months of follow-up (average follow-up 7 months), no local recurrence and distant metastasis were found. Conclusion Sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following radical resection of rectal cancer is feasible.
ObjectiveTo study feasibility of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following laparoscopic anterior resection of rectal cancer.MethodsThe clinical data of patients who underwent laparoscopic anterior resection of rectal cancer in our hospital from January 2017 to March 2020 were retrospectively collected. According to different surgical methods, they were divided into two groups: pedicled seromuscular sleeve sheath group (referred to as sleeve sheath operation group) and traditional operation group. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 87 patients with rectal cancer were included, 37 in the sleeve sheath operation group and 50 in the traditional operation group. There were no significant differences in the baseline data such as the gender, age, body mass index (BMI), complicating disease, distance from lower tumor margin to anal verge, histological classification, neoadjuvant radio- chemotherapy, and TNM stage between the two groups (P>0.05). There were no significant differences in the volumes of intraoperative blood loss, the number of lymph node dissection, the first postoperative anal exhaust time and the hospitalization expense between the two groups (P>0.05). Compared with the traditional operation group, the operative time of the sleeve sheath operation group was longer (P<0.05), the postoperative hospitalization time of the sleeve sheath operation group was shorter (P<0.05). The incidence of postoperative anastomotic leakage in the sleeve sheath operation group and the traditional group were 0.0% (0/37) and 12.0% (6/50), respectively, and the difference was statistically significant (P<0.05). There were no significant differences in the anastomotic stenosis, the lymphatic fistula and the incision infection between the two groups (P>0.05). All patients were followed-up for 6 to 36 months, with a median time of 21 months. No recurrence or death occurred.ConclusionThe sheath technique with seromuscular sleeve of pedicled colon can increase the anti tension ability of anastomotic stoma and reduce the incidence of anastomotic leakage, which is a safe and effective surgical method.
ObjectiveTo investigate the risk factors for anastomotic leakage after McKeown esophagectomy, and to establish a risk prediction model for early clinical intervention.MethodsWe selected 469 patients including 379 males and 90 females, with a median age of 67 (42-91) years, who underwent McKeown esophagectomy in our department from 2018 to 2019. The clinical data of the patients were analyzed.ResultsAmong the 469 patients, 7.0% (33/469) patients had anastomotic leakage after McKeown esophagectomy. Logistic analysis showed that the risk factors for anastomotic leakage were operation time >4.5 h, postoperative low albumin and postoperative hypoxemia (P<0.05). A prognostic nomogram model was established based on these factors with the area under the receiver operator characteristic curve of 0.769 (95%CI 0.677-0.861), indicating a good predictive value.ConclusionOperation time >4.5 h, postoperative low albumin and postoperative hypoxemia are the independent risk factors for anastomotic leakage after McKeown esophagectomy. Through the nomogram prediction model, early detection and intervention can be achieved, and the hospital stay can be shortened.
ObjectiveTo understand the related factors and prevention and treatment of anastomotic leakage after colorectal cancer operation.MethodThe literatures on the studies of colorectal anastomotic leakage in recent years were reviewed and analyzed.ResultsThe occurrence of postoperative anastomotic leakage of colorectal cancer was usually related to many factors, besides the patients’ nutritional status, body mass index, gender, smoking and drinking history, preoperative radiotherapy and chemotherapy, etc., as well as the distance between the anastomotic stoma and the anal margin and the ligation of the left colonic artery. The monitors of albumin, prealbumin, C-reactive protein, procalcitonin and other indicators might be better for early prediction of anastomotic leakage. The use of oral antibiotics while mechanical bowel preparation, intraoperative ICG fluorescence angiography, single-layer intestinal anastomosis, reducing the number of staplers, preserving the left colon artery, placing drainage tube through anus, and minimally invasive colorectal cancer resection might have some advantages in reducing the incidence of postoperative anastomotic leakage.ConclusionsAs a surgeon, risk factors associated with anastomotic leakage should be fully understood. It is of great significance to use related markers to identify early anastomotic leakage and timely intervene, and use of more accurate surgical procedures to reduce occurrence of anastomotic leakage.
ObjectiveTo analyze the risk factors for esophagogastric anastomotic leakage (EGAL) after esophageal cancer surgery, and to establish a risk prediction model for early prevention and treatment.MethodsClinical data of patients undergoing esophagectomy in our hospital from January 2013 to October 2020 were retrospectively analyzed. The independent risk factors for postoperative EGAL were analyzed by univariate and multivariate logistic regression analyses, and a clinical nomogram prediction model was established. According to whether EGAL occurred after operation, the patients were divided into an anastomotic fistula group and a non-anastomotic fistula group.ResultsA total of 303 patiens were enrolled, including 267 males and 36 females with a mean age of 62.30±7.36 years. The incidence rate of postoperative EGAL was 15.2% (46/303). The multivariate logistic regression analysis showed that high blood pressure, chronic bronchitis, peptic ulcer, operation way, the number of lymph node dissected, anastomotic way, the number of intraoperative chest drainage tube, tumor location, no-supplementing albumin in the first three days after operation, postoperative pulmonary infection, postoperative use of bronchoscope were the independent risk factors for EGAL after esophageal cancer surgery (P<0.05). A prognostic nomogram model was established based on these factors with the area under the receiver operating characteristic curve of 0.954 (95%CI 0.924-0.975), indicating a high predictive value.ConclusionThe clinical prediction model based on 11 perioperative risk factors in the study has a good evaluation efficacy and can promote the early detection, diagnosis and treatment of EGAL.
ObjectiveTo study the clinical significance of prognostic nutritional index (PNI) combined with neutrophil to lymphocyte ratio (NLR) in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.MethodsTo retrospectively analyze and collect the clinical data of 517 patients with gastric cancer who were diagnosed at the Third People’s Hospital of Shangqiu City from January 2016 to May 2020, all of the patients received radical gastrectomy. We explored the risk factors that affect the occurrence of postoperative anastomotic leakage, and explored the clinical significance of PNI combined with NLR on the third day after operation in predicting the occurrence of anastomotic leakage.ResultsAmong 517 patients undergoing radical gastrectomy, 61 had anastomotic leakage, and the incidence of anastomotic leakage was 11.8%. The results of multivariate logistic regression analysis showed that patients with preoperative diabetes and intraoperative blood loss ≥400 mL had a higher incidence of anastomotic leakage, and with the increase of NLR value on the 3rd and 5th day after operation, and the decrease of PNI value on the 3rd and 5th day after operation, the incidence of anastomotic leakage increased (P<0.05). The area under the curve of NLR, PNI, and NLR combined with PNI on the 3rd day after operation in predicting the occurrence of anastomotic leakage were 0.849, 0.581, and 0.949, respectively, and the differences were statistically significant (P<0.05), the sensitivity and specificity of NLR combined with PNI were higher than the individual indicator.ConclusionPNI combined with NLR on the 3rd day after operation has important clinical significance in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.
Objective To explore the strategy of intrathoracic anastomosis in patients with esophageal squamous cell carcinoma when the proximal esophagus is dilated to different degrees and explore its mechanism. Methods We retrospectively reviewed the clinical data of patients who underwent esophagectomy between 2014 and 2017 in West China Hospital. The patients were divided into two groups including a significant dilatation group with inner mucosal phase diameter (IMPD)≥17.9 mm and a non-significant dilatation group with IMPD<17.9 mm. And the patients were divided into two groups (a layered manual anastomosis group and a stapled anastomosis group) according to anastomosis method and propensity score matching was applied to adjust for potential confounders. Results We finally included 654 patients. There were 206 patients with 158 males and 48 females at average age of 62.21±7.72 years in the layerd manual analstomosis group and 448 patietns with 377 males and 71 females at average age of 62.57±8.42 years in the stapled anastomosis group. We also used Masson trichrome staining to assess the collagen fiber content in the esophagus. Compared with layered manual anastomosis, the incidence of anastomotic leakage was higher in the significant dilatation group than that in the stapled anastomosis group (original cohort: 3.8% vs. 10.7%, P=0.093; propensity score-matched cohort: 1.4% vs. 15.3%, P=0.004). And there was no significant difference in anastomotic leakage b etween layered manual anastomosis and stapled anastomosis in the non-significant dilatation group (original cohort: 4.7% vs. 4.2%, P=0.830; propensity score-matched cohort: 4.8% vs. 4.0%, P=0.206). Moreover, the average collagen fiber area ratio was significantly lower in the significant dilation group than that in the non-significant dilatation group (P=0.045). Conclusion There is a significant reduction in collagen fibers in the proximal esophageal wall tissue of esophageal squamous cell carcinoma patients with a IMPD≥17.9 mm. Intrathoracic layered manual anastomosis effectively reduces postoperative anastomotic leakage in these patients.
Objective To understand the changes of intestinal flora during perioperative period of colorectal cancer and the mechanism affecting the occurrence of postoperative anastomotic leakage, so as to improve perioperative management of patients and find possible measures to decrease the incidence rate of anastomotic leakage. Method The literature related to perioperative intestinal flora assessment, anastomotic healing, and anastomotic leakage of colorectal cancer in recent years was comprehensively searched in the CNKI, PubMed, and Embase databases and made an review. ResultsDue to the various perioperative interventions, the diversity and abundance of intestinal flora had changed after colorectal cancer surgery, and some conditional pathogenic bacteria such as Enterococcus faecalis, Pseudomonas aeruginosa, etc. increased obviously, which led to collagen degradation through the expression of bacterial collagenase or the excessive activation of matrix metalloproteinases in the host intestine, then might lead to the poor anastomotic healing and even the anastomotic leakage. ConclusionAlthough the evidence of effect of intestinal flora on anastomotic leakage mainly comes from animal experiments, it still shows the potential role of intestinal flora in the occurrence of anastomotic leakage after colorectal cancer surgery, and can be regulated by perioperative intervention, which suggests that it may provide a new strategy for prevention of anastomotic leakage.
ObjectiveTo investigate the diagnostic value of intra-intestinal angiography CT in patients with anastomotic leakage (AL) after rectal cancer resection.MethodsPatients who admitted to The Department of General Surgery of The No. 900 Hospital of The Joint Logistic Team from January 2013 to October 2018, who were diagnosed with rectal cancer and underwent rectal cancer resection with sphincter preserving surgery, were retrospectively collected in the study. All patients underwent routine imaging examination on the 7th day after rectal cancer operation. The retrograde contrast enema (RCE) was performed to obtain the abdominal X-ray film, then the pelvic CT scan was performed to get the CT image of the intestinal lumen. The films were reviewed by 2 senior radiologists, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RCE and intra-intestinal angiography CT in the diagnosis of AL after rectal cancer resection were evaluated. Evaluated the sensitivity of the CT image feature to predict AL after rectal cancer resection.ResultsThe sensitivity, specificity, PPV, and NPV of RCE in the diagnosis of AL after the rectal cancer resection were 69.23% (18/26), 98.64% (218/221), 85.71% (18/21), and 96.46% (218/226) respectively. The sensitivity, specificity, PPV, and NPV of intra-intestinal angiography CT were 96.15% (25/26), 99.09% (219/221), 92.59% (25/27), and 99.54% (219/220) respectively. The sensitivity and NPV of intra-intestinal angiography CT in diagnosis of AL were significantly higher than those of RCE (P<0.05). The sensitivity of contrast agent leakage to diagnosis of AL was the highest, reaching 96.15% (25/26).ConclusionsThe sensitivity of intra-intestinal angiography CT in the diagnosis of AL is high and the overall diagnostic efficiency is better than RCE, and the leakage of contrast agent is the main imaging feature of AL. It is significant to guide the clinical practice.