卵巢癌复杂多脏器切除术中结直肠吻合口漏的预测特征
本研究纳入2010至2025年意大利米兰国家肿瘤研究所的311例卵巢癌复杂肿瘤细胞减灭术患者，分析结直肠吻合口漏（AL）的术前与术中预测因素。AL发生率为7.4%（23例）。多因素分析显示，基线血淋巴细胞与单核细胞比值≥2.14与AL低风险独立相关（OR 0.38，p=0.046）；广泛盆腔病变（OR 7.35，p=0.005）和同期脾切除（OR 3.36，p=0.014）为AL的强预测因素。AL患者术后平均住院时间显著延长（18.7 vs. 9.3天，p<0.0001），再干预率更高（91.3% vs. 5.2%，p<0.0001），但AL对无病生存（Log-rank p=0.51）或总生存（Log-rank p=0.386）无显著影响。
要点
- 基线血LMR≥2.14与AL低风险独立相关（OR 0.38，p=0.046）。
- 广泛盆腔病变（OR 7.35，p=0.005）和同期脾切除（OR 3.36，p=0.014）为AL强预测因素。
- AL患者住院时间更长、再干预率更高，但生存无显著差异。
核心结论
- 基线血LMR≥2.14、广泛盆腔病变和同期脾切除可用于识别复杂肿瘤细胞减灭术后高AL风险患者，以考虑 upfront 保护性造口。
研究设计与样本
- 回顾性研究，纳入2010至2025年意大利IRCCS Istituto Nazionale dei Tumori di Milano妇科肿瘤单元治疗的311例卵巢癌患者，分为无AL组和AL组，进行单因素和多因素分析。
主要发现
- AL发生于23例患者（7.4%）。
- 多因素分析中，基线血LMR≥2.14与AL低风险独立相关（OR 0.38，p=0.046）。
- 广泛盆腔病变（OR 7.35，p=0.005）和同期脾切除（OR 3.36，p=0.014）为AL强预测因素。
- AL患者术后平均住院时间显著延长（18.7 vs. 9.3天，p<0.0001），再干预率更高（91.3% vs. 5.2%，p<0.0001）。
- AL患者接受辅助治疗的可能性较低（p=0.062），但AL对无病生存（Log-rank p=0.51）或总生存（Log-rank p=0.386）无显著影响。
关键数值与推荐
- 基线血LMR≥2.14与AL低风险独立相关（OR 0.38，p=0.046）。
- 广泛盆腔病变预测AL（OR 7.35，p=0.005）。
- 同期脾切除预测AL（OR 3.36，p=0.014）。
临床怎么用
- 对于基线血LMR≥2.14、广泛盆腔病变或同期脾切除的卵巢癌患者，可考虑 upfront 保护性造口以降低AL风险。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: The aim of the present study was to identify preoperative and intraoperative predictive features of colorectal anastomotic leakage (AL) and to report its possible implications on overall and disease-free survival in patients treated with complex cytoreductive surgery for ovarian cancer. METHODS: 311 patients affected by ovarian cancer, treated at the Gynecology Oncology Unit of IRCCS Istituto Nazionale dei Tumori di Milano (Italy) from 2010 to 2025, were retrieved. Patients were divided into two groups: those without AL during the postoperative course and those with clinical and/or radiological evidence of AL. Predictors of AL were then analyzed by univariate and multivariate analyses. RESULTS: AL occurred in 23 patients (7.4%). At multivariate analysis, a lymphocyte-to-monocyte ratio ≥ 2.14 on baseline blood count was independently associated to low likelihood of AL (OR 0.38, p = 0.046). Conversely, extensive pelvic disease (OR 7.35, p = 0.005) and concurrent splenectomy (OR 3.36, p = 0.014) were strong predictors of AL. Mean postoperative hospitalization was significantly longer in AL patients (18.7 vs. 9.3 days, p < 0.0001), and the re-intervention rate was higher (91.3% vs. 5.2%, p < 0.0001). AL patients were less likely to receive adjuvant treatment (p = 0.062), but no impact of AL was observed on disease-free survival (Log-rank p = 0.51) or overall survival (Log-rank p = 0.386). CONCLUSIONS: These features might be taken into account to select those patients with a high likelihood of AL who could be addressed to upfront protective ostomy.
引用
- Sorrentino L, Bogani G, Chiappa V, et al. Predictive features of anastomotic leakage after colorectal resection in complex multivisceral cytoreductive surgery for ovarian cancer. Gynecol Oncol. 2026. PMID: 42034008. doi:10.1016/j.ygyno.2026.04.009
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。