Introduction
Patients and methods
Risk evaluation scores
Classification and severity of complications
Evaluation of risk factors for anastomotic leakage
Statistical analysis
Results
Variable |
n (%) |
---|---|
Sex | |
Male | 190 (73) |
Female | 70 (28) |
Age (year) | |
Range | 28–92 |
Median | 63 |
Location of the tumor | |
Upper and middle | 112 (43) |
Lower | 148 (57) |
Neoadjuvant CRT | |
Yes | 202 (77) |
No | 58 (23) |
Concurrent chemotherapy | |
UFT | 37 (19) |
S-1 | 165 (81) |
Radiation | |
40 or 45 Gy | 183 (91) |
20 Gy and IOR | 19 (9) |
Surgical procedure | |
LAR | 187 (70) |
APR | 73 (30) |
Histological type | |
Well | 129 (50) |
Moderate | 92 (35) |
Poor | 1 (0.3) |
Mucinous | 12 (5) |
pCR | 26 (10) |
Lymphatic invasion | |
Positive | 121 (46) |
Negative | 138 (53) |
Unknown | 1 (0.3) |
Venous invasion | |
Positive | 126 (48) |
Negative | 133 (51) |
Unknown | 1 (0.3) |
Pathological stage (include ypStage) | |
0 | 29 (11) |
I | 79 (30) |
II | 78 (31) |
III | 73 (28) |
Complication | C–D grade |
n (%) |
---|---|---|
Infectious complication | 3a | 18 (27.6) |
3b | 1 (1.5) | |
4 | 0 (0) | |
Anastomotic leakage | 3a | 6 (27.2) |
3b | 11 (55.0) | |
4 | 1 (5.0) | |
Bowel obstruction | 3a | 8 (26.6) |
3b | 8 (26.6) | |
4 | 0 (0) |
Evaluation of risk scores and the incidences of complications (Table 3)
Complication | Cut-off value | Incidence (%) | OR | 95% CI |
p value |
---|---|---|---|---|---|
E-PASS CRS | |||||
All complication | <0.294 | 16/134 (11.9) | Reference | ||
≥0.294 | 40/126 (31.7) | 3.45 | 1.84–6.73 | <0.0001 | |
Infectious complication | <0.294 | 5/134 (3.7) | Reference | ||
≥0.294 | 14/126 (11.1) | 3.23 | 1.19–10.23 | 0.0202 | |
Anastomotic leakage | <0.294 | 4/72 (5.5) | Reference | ||
≥0.294 | 8/39 (20.5) | 4.38 | 1.28–17.46 | 0.0183 | |
Bowel obstruction | <0.294 | 5/134 (3.7) | Reference | ||
≥0.294 | 11/126 (8.7) | 2.46 | 0.86–8.02 | 0.0906 | |
PNI | |||||
All complication | ≥41 | 29/179 (16.1) | Reference | ||
<40 | 27/81 (33.3) | 2.60 | 1.41–4.80 | 0.0022 | |
Infectious complication | ≥41 | 12/179 (6.7) | Reference | ||
<40 | 7/81 (8.6) | 1.32 | 0.47–3.42 | 0.5750 | |
Anastomotic leakage | ≥41 | 8/85 (9.4) | Reference | ||
<40 | 4/26 (15.4) | 1.75 | 0.48–6.35 | 0.3907 | |
Bowel obstruction | ≥41 | 7/179 (3.9) | Reference | ||
≥40 | 9/81 (11.1) | 3.08 | 1.10–8.94 | 0.0311 | |
NLR | |||||
All complication | <2.21 | 17/123 (13.8) | Reference | ||
≥2.21 | 39/137 (28.5) | 2.50 | 1.35–4.81 | 0.0033 | |
Infectious complication | <2.21 | 4/123 (3.2) | Reference | ||
≥2.21 | 15/137 (10.9) | 3.65 | 1.28–13.11 | 0.0138 | |
Anastomotic leakage | <2.21 | 10/62 (16.1) | Reference | ||
≥2.21 | 2/49 (4.08) | 4.51 | 1.11–30.38 | 0.0329 | |
Bowel obstruction | <2.21 | 5/123 (4.0) | Reference | ||
≥2.21 | 11/137 (8.0) | 2.06 | 0.69–6.10 | 0.1842 | |
Surgcal apgar score | |||||
All complication | ≥5 | 48/239 (20.0) | Reference | ||
<5 | 8/21 (38.1) | 2.46 | 0.92–6.18 | 0.0692 | |
Infectious complication | ≥5 | 14/239 (5.8) | Reference | ||
<5 | 5/21 (23.8) | 5.02 | 1.47–15.09 | 0.0119 | |
Anastomotic leakage | ≥5 | 12/108 (11.1) | |||
<5 | 0/3 | – | – | 0.5410 | |
Bowel obstruction | ≥5 | 15/239 (6.3) | Reference | ||
<5 | 1/21 (4.8) | 0.74 | 0.09–5.94 | 0.7819 | |
CR-POSSUM | |||||
All complication | <18 | 18/124 (14.5) | Reference | ||
≥18 | 38/136 (27.9) | 2.26 | 1.22–4.29 | 0.0086 | |
Infectious complication | <18 | 3/124 (2.4) | Reference | ||
≥18 | 16/136 (11.8) | 5.37 | 1.52–18.93 | 0.0038 | |
Anastomotic leakage | <18 | 7/75 (9.3) | Reference | ||
≥18 | 5/36 (13.8) | 1.30 | 0.37–4.24 | 0.6660 | |
Bowel obstruction | <18 | 5/124 (4.0) | Reference | ||
≥18 | 11/136 (8.1) | 2.09 | 1.73–6.81 | 0.1681 |
Evaluation of risk factors for anastomotic leakage
Variable | Patients with leakage | Patients without leakage |
p value | |
---|---|---|---|---|
Sex | ||||
Male | 11 | 122 | ||
Female | 1 | 53 | 0.1045 | |
Age | ||||
Range | 43–77 | 28–92 | ||
Median | 64.5 | 63 | 0.5691 | |
BMI | ||||
≥25 | 4 | 32 | ||
<25 | 8 | 143 | 0.2009 | |
Smoking history | ||||
No | 4 | 86 | ||
Yes | 8 | 89 | 0.3168 | |
Location of the tumor | ||||
Upper or middle | 7 | 104 | ||
Lower | 5 | 71 | 0.9404 | |
pStage | ||||
0 | 4 | 21 | ||
I | 3 | 54 | ||
II | 2 | 49 | ||
III | 3 | 51 | 0.2083 | |
CRT | ||||
No | 2 | 40 | ||
Yes | 10 | 135 | 0.6191 | |
E-PASS CRS | ||||
<0.294 | 4 | 104 | ||
≥0.294 | 8 | 71 | 0.0767 | |
NLR | ||||
<2.21 | 2 | 86 | ||
≥2.21 | 10 | 89 | 0.0292 |
OR | 95% CI |
p value | |
---|---|---|---|
Sex | |||
Female | Reference | ||
Male | 3.66 | 0.60–71.08 | 0.1778 |
BMI | 1.31 | 1.02–1.72 | 0.0775 |
Smoking history | |||
No | Reference | ||
Yes | 1.76 | 0.47–7.72 | 0.4018 |
Location of the tumor | |||
Upper or middle | Reference | ||
Lower | 1.59 | 0.42–6.61 | 0.4903 |
CRT | |||
No | Reference | ||
Yes | 2.13 | 0.42–16.82 | 0.3808 |
pStage | |||
0 | Reference | ||
1 | 5.44 | 0.59–60.06 | 0.1317 |
2 | 7.60 | 0.90–84.88 | 0.0617 |
3 | 4.92 | 0.61–48.42 | 0.1322 |
E-PASS CRS | |||
<0.294 | Reference | ||
≥0.294 | 6.85 | 1.63–39.63 | 0.0075 |
NLR | |||
<2.21 | Reference | ||
≥2.21 | 8.24 | 1.61–76.07 | 0.0089 |
Score | COV | OR | 95% CI |
p value | Accuracy rate (%) | Sensitivity (%) | Specificity (%) | PPV (%) | NPV (%) |
---|---|---|---|---|---|---|---|---|---|
E-PASS CRS | 0.294 | 4.38 | 1.28–17.46 | 0.0183 | 68.4 | 66.6 | 68.6 | 20.5 | 94.4 |
PNI | 40 | 1.75 | 0.48–6.35 | 0.3907 | 27.0 | 66.6 | 22.2 | 9.4 | 84.6 |
NLR | 2.21 | 4.51 | 1.11–30.38 | 0.0329 | 51.3 | 83.3 | 47.4 | 16.1 | 95.9 |
SAS | 5 | 0 | – | 0.5410 | 13.5 | 100 | 96.9 | 11.0 | 100 |
CR-POSSUM | 18 | 1.30 | 0.37–4.24 | 0.6660 | 34.2 | 58.3 | 31.3 | 9.3 | 86.1 |