首页|术前营养状态对新辅助治疗后极限保肛手术患者术后并发症的影响:基于DACCA数据库的分析研究

术前营养状态对新辅助治疗后极限保肛手术患者术后并发症的影响:基于DACCA数据库的分析研究

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目的 了解术前营养状态对低位/超低位直肠癌患者接受新辅助治疗联合极限保肛手术后并发症发生的影响.方法 通过四川大学华西医院的肠癌数据库(Database from Colorectal Cancer,DACCA)回顾性收集2009年1月至2020年12月期间接受新辅助治疗联合极限保肛手术的直肠癌患者,然后根据营养风险筛查2002(nutrition risk screening 2002,NRS2002)评分工具评估的营养状态分为无(NRS2002评分＜3分)和有(NRS2002评分≥3分)营养风险进行分析,分析有或无营养风险患者术后并发症发生情况和生存情况.其中术后并发症分为早期(术后30 d内发生的并发症)、中期(术后30 d以后且180 d以内发生的并发症)和长期(术后180 d及以后发生的并发症),生存情况指标为总生存和疾病特异性生存.结果 从DACCA数据库中检索到符合本研究纳入条件的患者680例.其中评估为无营养风险者500例(73.5％)、有营养风险者180例(26.5％).术后随访时间为0～152个月(平均48.9个月),生存543例(79.9％),其中无瘤生存患者471例(86.7％),带瘤生存患者72例(13.3％);死亡137例(20.1％),其中癌性死亡患者122例(89.1％),非癌性死亡患者15例(10.9％).术后早期并发症48例(7.1％)、近期并发症51例(7.5％)及长期并发症17例(2.5％),这3种并发症在有和无营养风险患者之间比较差异均无统计学意义(x2=3.749.P=0.053;x2=2.205、P=0.138;x2=0.310、P=0.578),术后不同时期发生的具体并发症除了术后早期的吻合口漏在有营养风险患者中高于无营养风险患者(P=0.034)外,其他具体并发症发生率在二者间比较差异均无统计学意义(P＞0.05).采用Kaplan-Meier法绘制的生存曲线显示,有和无营养风险患者的总生存和疾病特异性生存曲线比较差异均未见有统计学意义(x2=3.316、P=0.069;x2=3.712、P=0.054).结论 从本研究分析结果看,对接受新辅助治疗后进行极限保肛手术的直肠癌患者,术前存在营养风险的患者在术后30 d内容易发生吻合口漏,虽然未发现有和无营养风险患者间在其他术后并发症和长期生存结果方面差异有统计学意义,但是对患者术前的营养管理仍不可忽视.
Impact of preoperative nutritional status on postoperative complications in patients undergoing extreme sphincter-preserving surgery following neoadjuvant therapy:a study based on DACCA database
Objective To understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy.Methods The patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer(DACCA),and then who were assigned into a nutritional risk group(the score was low than 3 by the Nutrition Risk Screening 2002)and non-nutritional risk group(the score was 3 or more by the Nutrition Risk Screening 2002).The postoperative complications and survival were analyzed for the patients with or without nutritional risk.The postoperative complications were defined as early-term(complications occurring within 30 d after surgery),middle-term(complications occurring during 30-180 d after surgery),and long-term(complications occurring at 180 d and more after surgery).The survival indicators included overall survival and disease-specific survival.Results A total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database.Among them,there were 500(73.5％)patients without nutritional risk and 180(26.5％)patients with nutritional risk.The postoperative follow-up time was 0-152 months(with average 48.9 months).Five hundreds and forty-three survived,including 471(86.7％)patients with free-tumors survival and 72(13.3％)patients with tumors survival.There were 137 deaths,including 122(89.1％)patients with cancer related deaths and 15(10.9％)patients with non-cancer related deaths.There were 48(7.1％)cases of early-term postoperative complications,51(7.5％)cases of middle-term complications,and 17(2.5％)cases of long-term complications.There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk(x2=3.749,P=0.053;x2=2.205,P=0.138;x2=310,P=0.578).The specific complications at different stages after surgery(excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk,P=0.034)had no statistical differences between the two groups(P＞0.05).The survival curves(overall survival and disease-specific survival)using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk(x2=3.316,P=0.069;x2=3.712,P=0.054).Conclusions From the analysis results of this study,for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy,the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery.Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk,preoperative nutritional management for them cannot be ignored.

rectal cancerneoadjuvant therapyextreme sphincter-preserving surgerynutritional riskpostoperative complicationsprognosisDACCA database

许勤宸、夏榛蔓、林雨昕、阿伊孜巴克孜·麦木塔吾拉、谭坤、汪晓东、李立

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四川大学华西医院胃癌中心(成都 610041)

四川大学华西临床医学院(成都 610041)

四川省卫生健康信息中心(成都 610041)

四川大学华西医院普通外科胃肠外科病房(成都 610041)

四川大学华西医院结直肠肿瘤中心(成都 610041)

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直肠癌 新辅助治疗 极限保肛 营养风险 术后并发症 预后 DACCA数据库

四川省卫生健康信息中心2023年度"卫生健康数字化+临床应用发展"重大项目四川省科技厅重点研发项目(省院省校科技合作)

2023ZXKY060022024YFHZ0060

2024

10.7507/1007-9424.202405058

中国普外基础与临床杂志
四川大学华西医院

中国普外基础与临床杂志

CSTPCD
影响因子：0.858
ISSN：1007-9424
年,卷(期)：2024.31(7)
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