Risk factors for anastomotic fistula development after radical colon cancer surgery and their impact on prognosis

Table 1 Comparison of clinical features of patients after radical colon cancer surgery

Item, n (%)	Anastomotic fistula group	Non-anastomotic fistula group	t/χ2	P value
Gender
Male	19 (50.0)	236 (52.4)	0.084	0.772
Female	19 (50.0)	214 (47.6)
Age (yr)	58.95 ± 11.91	52.90 ± 12.7	-2.921	0.004
Hypertension or not
Yes	17 (44.7)	171 (38.0)	0.672	0.413
No	21 (55.3)	279 (62.0)
Diabetes or not
Yes	16 (42.1)	110 (24.4)	5.706	0.017
No	22 (57.9)	340 (75.6)
Site of lesion
Left hemi-colon	17 (44.7)	227 (50.4)	0.892	0.640
Right hemi-colon	15 (39.5)	144 (25.3)
Transverse colon	6 (15.8)	79 (17.6)
Type of organization
Low to moderately differentiated adenocarcinoma	27 (71.1)	325 (72.2)	0.024	0.877
Highly differentiated adenocarcinoma	11 (28.9)	125 (27.8)
Type of TNM
Type of I-II	20 (52.6)	323 (71.8)	6.151	0.013
Type of III	18 (47.4)	127 (28.2)
Surgery method
Laparoscopic radical surgery	9 (23.7)	278 (61.8)	20.991	0.000
Traditional radical surgery	29 (76.3)	172 (38.2)
Lymph node metastasis or not
Yes	11 (28.9)	122 (27.1)	0.060	0.807
No	27 (71.1)	328 (72.9)
With preoperative adjuvant chemotherapy or not
Yes	13 (34.2)	85 (18.9)	5.125	0.024
No	25 (65.8)	365 (81.1)
Post-operative ICU stay
Yes	5 (13.2)	20 (4.4)	5.474	0.019
No	33 (86.8)	430 (95.6)
Type of pathology
Ductal gland	30 (78.9)	332 (73.8)	0.489	0.484
Mucus gland	8 (21.1)	118 (26.2)

TNM: Tumor node metastasis; ICU: Intensive care unit.

Table 2 Comparison of perioperative patients after radical colon cancer surgery

Item (mean ± SD)	Operating time (min)	Intraoperative bleeding (mL)	Post-operative time to exhaustion (d)	Postoperative hospitalization time (d)
Anastomotic fistula group	187.39 ± 16.31	229.21 ± 60.81	2.37 ± 0.91	11.76 ± 2.57
Non-anastomotic fistula group	179.96 ± 21.32	187.51 ± 60.51	2.21 ± 0.90	10.76 ± 2.11
t value	-2.098	-4.078	-1.053	-2.777
P value	0.036	0.000	0.293	0.006

Table 3 Comparison of preoperative and postoperative two groups

Item (mean ± SD)	CEA (ng/mL)	CA125 (U/mL)	Alb (g/L)	TP (g/L)	Hb (g/L)	K (mmol/L)
Preoperative group
Anastomotic fistula group	7.71 ± 0.77	51.51 ± 10.78	33.87 ± 4.74	69.13 ± 9.31	135.18 ± 15.21	3.96 ± 0.18
Non-anastomotic fistula group	7.74 ± 0.81	52.53 ± 10.54	36.22 ± 4.72	69.77 ± 8.04	133.46 ± 13.64	3.94 ± 0.17
t value	0.240	0.574	2.951	0.465	-0.739	-0.549
P value	0.811	0.567	0.003	0.642	0.460	0.583
Postoperative group
Anastomotic fistula group	5.12 ± 0.90	39.34 ± 10.00	27.70 ± 3.24	55.32 ± 8.83	115.57 ± 14.00	4.89 ± 0.49
Non-anastomotic fistula group	5.01 ± 0.87	39.93 ± 10.11	29.92 ± 3.56	58.37 ± 8.67	120.90 ± 14.06	4.71 ± 0.47
t value	-0.749	0.344	3.716	2.045	2.246	-2.266
P value	0.454	0.731	0.000	0.047	0.025	0.024

CEA: Carcinoembryonic antigen; CA125: Carbohydrate antigen; Alb: Albumin; TP: Total protein; Hb: Hemoglobin; K: Kalium.

Table 4 Functional Assessment of Cancer Therapy-Colorectal of patients after radical colon cancer surgery in two groups

Item (mean ± SD)	First group			Second group
	PWB	SWB	EWB	FWB	CCS	Total
Anastomotic fistula group	12.50 ± 3.80	18.24 ± 3.77	15.50 ± 3.45	12.66 ± 3.78	15.89 ± 4.59	74.79 ± 11.86
Non-anastomotic fistula group	15.62 ± 3.94	20.06 ± 3.54	18.32 ± 3.36	15.53 ± 4.39	19.52 ± 3.98	89.05 ± 13.32
t value	4.705	3.024	4.962	3.909	4.724	6.389
P value	0	0.003	0	0	0	0

FACT-C: Functional Assessment of Cancer Therapy-Colorectal cancer; PWB: Physical well-being; SWB: Social well-being; EWB: Emotional well-being; FWB: Functional well-being; CCS: Colorectal cancer subscale.

Table 5 Survival and recurrence of patients in 1 year to 3 years after surgery in two groups

Item, n (%)	Recurrence 1 yr after surgery		Recurrence 2 yr after surgery		Recurrence 3 yr after surgery		Survival 1 yr after surgery		Survival 2 yr after surgery		Survival 3 yr after surgery
	Yes	No	Yes	No	Yes	No	Yes	No	Yes	No	Yes	No
Anastomotic fistula group	4 (10.5)	34 (89.5)	6 (15.8)	32 (84.2)	7 (18.4)	31 (81.6)	34 (89.5)	4 (10.5)	32 (84.2)	6 (15.8)	28 (73.7)	10 (26.3)
Non-anastomotic fistula group	22 (4.9)	428 (95.1)	40 (8.9)	410 (91.1)	50 (11.1)	400 (88.9)	435 (96.7)	15 (3.3)	412 (91.6)	38 (8.4)	382 (84.9)	68 (15.1)
t value	2.208		1.954		1.815		4.845		2.304		3.276
P value	0.137		0.162		0.178		0.028		0.129		0.07

Table 6 Binary Logistics regression of anastomotic after radical colon cancer surgery

Related factor	B	SE	Wald	P value	OR	95%CI
						Upper	Lower
Surgery method	-2.304	0.878	6.890	0.009	0.100	0.558	0.018
Age (yr)	0.042	0.017	5.882	0.015	1.043	1.079	1.008
Diabetes	0.602	0.413	2.127	0.145	1.827	4.105	0.813
Type of TNM	0.849	0.415	4.187	0.041	2.337	5.268	1.036
Preoperative adjuvant chemotherapy	0.687	0.457	2.261	0.133	1.987	4.865	0.812
Post-operative ICU stay	1.348	0.664	4.124	0.042	3.850	14.144	1.048
Operating time (min)	-0.015	0.013	1.424	0.233	0.985	1.010	0.960
Intraoperative bleeding (mL)	-0.005	0.006	0.561	0.454	0.995	1.007	0.984
Postoperative hospitalization time (d)	0.160	0.093	2.993	0.084	1.174	1.408	0.979
Preoperative Alb (g/L)	-0.023	0.051	0.210	0.647	0.977	1.080	0.883
Postoperative Alb (g/L)	-0.203	0.078	6.693	0.010	0.817	0.952	0.701
Postoperative TP (g/L)	-0.038	0.025	2.406	0.121	0.963	1.010	0.917
Postoperative Hb (g/L)	-0.030	0.015	4.194	0.041	0.970	0.999	0.943
Postoperative K (mmol/L)	0.960	0.441	4.742	0.029	2.612	6.198	1.101

SE: Standard error; OR: Odds ratio; CI: Confidence interval; TNM: Tumor node metastasis; ICU: Intensive care unit; Alb: Albumin; Hb: Hemoglobin; K: Kalium.

Table 7 Linear regression of Functional Assessment of Cancer Therapy–Colorectal anastomotic fistula after radical colon cancer surgery

Related factor	B	SE	t value	P value
Anastomotic fistula	-11.180	2.506	-4.461	0.000
Surgery method	0.060	3.204	0.019	0.985
Age (yr)	-0.148	0.049	-3.012	0.003
Gender	0.221	1.155	0.191	0.848
Hypertension	0.383	1.183	0.323	0.747
Diabetes	-3.292	1.348	-2.443	0.015
Site of lesion	-0.172	0.765	-0.224	0.823
Type of organization	-0.172	1.288	-0.134	0.894
Type of TNM	-2.414	1.322	-1.826	0.069
Lymph node metastasis	-2.694	1.286	-2.094	0.037
Preoperative adjuvant chemotherapy	-0.196	1.511	-0.130	0.897
Post-operative ICU stay	0.480	2.665	0.180	0.857
Type of pathology	-6.303	1.322	-4.768	0.000
Operating time (min)	0.040	0.036	1.116	0.265
Intraoperative bleeding (mL)	-0.014	0.024	-0.572	0.567
Post-operative time to exhaustion (d)	0.731	0.748	0.977	0.329
Postoperative hospitalization time (d)	-0.242	0.270	-0.894	0.372
Preoperative CEA (ng/mL)	0.912	0.709	1.287	0.199
Postoperative CEA (ng/mL)	-1.778	0.782	-2.274	0.023
Preoperative CA125 (U/mL)	0.488	0.170	2.865	0.004
Postoperative CA125 (U/mL)	-0.416	0.178	-2.333	0.020
Preoperative Alb (g/L)	0.077	0.158	0.490	0.624
Postoperative Alb (g/L)	0.381	0.209	1.818	0.070
Preoperative TP (g/L)	0.020	0.178	0.114	0.910
Postoperative TP (g/L)	0.018	0.168	0.108	0.914
Preoperative Hb (g/L)	0.060	0.132	0.455	0.649
Postoperative Hb (g/L)	-0.068	0.131	-0.523	0.601
Preoperative K (mmol/L)	0.244	3.504	0.070	0.945
Postoperative K (mmol/L)	0.437	1.239	0.353	0.724

SE: Standard error; TNM: Tumor node metastasis; ICU: Intensive care unit; CEA: Carcinoembryonic antigen; CA125: Carbohydrate antigen; Alb: Albumin; TP: Total protein; Hb: Hemoglobin; K: Kalium.