Objectives To investigate the risk factors for anastomotic structural malhealing after laparoscopic intersphinc-teric resection(lap-ISR)for rectal cancer and its impact on patient prognosis.Methods We retrospectively analyzed the clinical data of 537 patients with ultra-low rectal cancer who underwent lap-ISR by the same surgical team from January 2012 to March 2023.Patients were divided into an anastomotic structural malhealing group(n=36)and a non-malhealing group(n=501)based on the occurrence of anastomotic structural malhealing.We analyzed the risk factors for anastomotic structural malhealing and studied its effect on long-term survival.Results A total of 36 cases of anasto-motic structural malhealing were diagnosed more than 6 months after surgery,including 22 cases(61.1％)of anastomotic stenosis,5 cases(13.9％)of rectovaginal fistula and anastomotic leakage after the return of the stoma,3 cases(8.3％)of pelvic abscess,and 1 case(2.8％)of rectovesical fistula.Statistically significant differences were observed between the two groups in terms of preoperative chemoradiotherapy,distance from the anastomosis to the anal verge,and postopera-tive anastomotic leakage(P＜0.05).Preoperative chemoradiotherapy(OR=3.397,95％CI:1.059-10.892,P=0.040)and postoperative anastomotic leakage(OR=83.398,95％CI:29.761-233.701,P＜0.001)were independent risk factors for anas-tomotic structural malhealing after lap-ISR.Follow-up was completed for all patients as of March 2023,with a follow-up duration ranging from 6 to 134 months and a median follow-up time of 43 months.The 5-year overall survival rate was 92.6％in the anastomotic structural malhealing group and 90.6％in the non-malhealing group,showing no statistically sig-nificant difference(P=0.762).Similarly,the 5-year disease-free survival rate was 76.1％in the malhealing group and 82.9％in the non-malhealing group,with no significant difference(P=0.235).Conclusion Preoperative chemoradio-therapy and postoperative anastomotic leakage are independent risk factors for anastomotic structural malhealing after lap-ISR,but they do not affect the 5-year overall and disease-free survival rates in these patients.
维普
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