Influencing factors for permanent protective stoma in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy and radical resection
Objective To investigate the influencing factors for permanent protective stoma in locally advanced rectal cancer(LARC)patients after neoadjuvant chemoradiotherapy(nCRT)and radical resection.Methods The retrospective case-control study was conducted.The clinicopatho-logical data of 216 patients with LARC who were admitted to Peking Union Medical College Hospital from June 2019 to May 2022 were collected.There were 144 males and 72 females,aged 60(53,68)years.All patients underwent nCRT followed by radical resection and protective stoma.Observation indicators:(1)permanent protective stoma and anastomotic complications after nCRT and radical resection;(2)influencing factors for permanent protective stoma after nCRT and radical resection;(3)influencing factors for anastomotic complications after nCRT and radical resection.Comparison of measurement data with normal distribution between groups was performed using the independent sample t test.Comparison of measurement data with skewed distribution between groups was performed using the Mann-Whitney U rank sum test.Comparison of count data between groups was performed using the chi-square test or Fisher exact probability.Univariate analysis was conducted using appropriate statistical methods based on the data type.Factors with P＜0.15 in univariate analysis were included in binary Logistic regression for multivariate analysis using a forward stepwise method based on maximum likelihood estimation.Results(1)Permanent protective stoma and anastomotic compli-cations after nCRT and radical resection.All the 216 patients were followed up of 40(23,51)months.Of the 216 patients,36 cases developed permanent protective stoma,of which 24 cases could not have stoma reversal based on preoperative evaluation,while 12 cases required re-colostomy with transverse colostomy after complications from reversal surgery.Of the 216 patients,25 cases deve-loped anastomotic-related complications.(2)Influencing factors for permanent protective stoma after nCRT and radical resection.Results of multivariate analysis showed that anastomotic-related compli-cation was an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection(odd ratio=17.503,95％confidence interval as 6.097-50.244,P＜0.05).(3)Influ-encing factors for anastomotic complications after nCRT and radical resection.Results of multivariate analysis showed that age ≤50 years,low body mass index,prolonged operation time were all inde-pendent risk factors for anastomotic-related complications in LARC patients after nCRT and radical resection(odd ratio=0.385,0.770,1.105,95％confidence interval as 0.151-0.979,0.654-0.907,1.007-1.023,P＜0.05).Conclusions Anastomotic-related complication is an independent risk factor for permanent protective stoma in LARC patients after nCRT and radical resection.Age ≤50 years,low body mass index,prolonged operation time are independent risk factors for anastomotic-related complications in LARC after nCRT and radical resection.
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