OBJECTIVETo explore the related factors of anastomotic leakfollowing anterior resection for the rectal cancer and the association of the preoperative nutritional risk screening 2002(NRS2002) score.

METHODSClinical data of 396 rectal cancer patients who underwent elective anterior resection from January 2010 to July 2015 at Affiliated Lu'an Hospital of Anhui Medical University were collected. Patient's nutritional risk score on admission was calculated by NRS2002 scoring system according to original medical records. NRS2002 score less than 3 was defined as nutritious risk. Chi-squared test, or Fisher exact test and multivariate logistic regression wereused to analyze the association of the clinical pathological factors and NRS2002 risk factor with anastomotic leak.

RESULTSOf the 396 patients, NRS2002 score≥3, and anastomotic leak occurred in 157(39.6%) and 13(3.3%), respectively. In univariate analysis, different ages, NRS2002 score, preoperative intestinal obstruction, distance from anastomosis to anal vergeand tumor TNM stage were significantly associated with postoperative anastomotic leak(all P<0.05). The incidence of postoperative anastomotic leak among patients with NRS2002 score≥3 was significantly higher than those with NRS2002 score<3[6.4%(10/157) vs. 1.3%(3/239), χ(2)=7.806, P=0.005]. Multivariate analysis showed that NRS2002 score≥3(OR=3.988, 95% CI:1.004-15.837, P=0.049), existence of preoperative intestinal obstruction(OR=5.780, 95% CI:1.320 ~ 25.311, P=0.020),distance from anastomosis to anal verge≤5 cm(OR=0.236, 95% CI: 0.071 ~ 0.785, P=0.019) were the independent risk factors of anastomotic leak following anterior resection for the rectal cancer.

CONCLUSIONRectal cancer patients undergoing anterior resection with preoperative NRS2002 score≥3 should receive reasonable perioperative nutritional support to prevent anastomotic leak.

Anastomotic Leak ; epidemiology ; prevention & control ; Chi-Square Distribution ; Humans ; Logistic Models ; Multivariate Analysis ; Nutritional Support ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Risk Factors

Objective: To investigate routine blood test results and secular changes among Tibetan children and adolescents aged from 3 to 19 in the plateau, and to provide the basis for reference range of routine blood test for this population. Methods: A total of 1 568 Tibetan children and adolescents aged from 3 to 19 living in Shigatse, Tibet were selected by cluster random sampling method. Routine blood test results and its secular trends were compared by age and gender. Results: Significantly differences were found in red blood cell(RBC), hemoglobin(HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin(MCH), white blood cell(WBC), neutrophil(NEU), neutrophil percentage (NEU%), lymphocyte(LYM), lymphocyte percentage(LYM%)，monocyte percentage(MON%)，eosinophil percentage(EOS%),basophil percentage(BAS%) and platelet(PLT) among the four age groups of 3-5, 6-12, 13-15, and 16-19 years ( F/H =60.22, 179.41, 249.45, 115.03, 74.90, 14.33 , 33.46, 78.90, 49.20, 97.29, 24.45,24.28,42.65,20.10, P <0.05). Among red blood cell indexes, RBC, HGB, HCT,MCH increased with age in boys( F =148.77, 493.04, 623.14, 249.92, P <0.05), but there was no similar trend in girls( F =1.37, 0.15, 2.94, 0.11, P >0.05). HCT showed significant sex differences among the four age groups of 3-5 years, 6-12 years, 13-15 years, and 16-19 years [(41.33±2.31)% vs (41.98±2.40)%; (43.28±2.60)% vs ( 43.75 ±2.36)%; (46.20±3.11)% vs (44.83±2.67)%; (51.10±4.15)% vs (43.61±4.70)%, t =-2.10, -2.88, 3.50, 10.82, P <0.05]. WBC, NEU, NEU%, LYM, LYM%, monocyte(MON), and MON% increased significantly with age in both boys and girls ( P <0.05). From the age of 12 to 13, RBC, HGB and HCT in Tibetan male and female adolescents showed an opposite trend and widened gradually. Conclusion Red blood cell index shows significantly different trends among Tibetan adolescents and children of different ages and genders. Regional nationality, age, gender, and other factors should be considered when developing the reference value range of blood routine index.