Patient characteristics.
The clinical characteristics of HUA and UA group were shown in Table 1. There were 1147 consecutive patients who have undergone Dixon surgery for rectal cancer, including 153 patients with HUA and 994 patients with UA. Among them, 58 women (37.9%) and 95 men (62.1%) were in the HUA group, with an average age of 65.23 ± 10.89 years. There were 457 females (46.0%) and 537 males (54.0%) in the UA group, with an average age of 56.07 ± 12.75 years. There were no significant differences in age, gender, TNM stage and histological differentiation between HUA group and UA group, but there were significant differences in body mass index (BMI) (P = 0.044).
Table 1. The clinical characteristics of HUA and UA group
Characteristics
|
HUA(n=153)
|
UA(n=994)
|
χ2
|
P
|
Age
|
|
|
1.687
|
0.217
|
>60
|
71(46.4%)
|
406(40.8%)
|
|
|
≤60
|
82(53.6%)
|
588(59.2%)
|
|
|
Gender
|
|
|
3.488
|
0.067
|
Male
|
95(62.1%)
|
537 (54.0%)
|
|
|
Female
|
58(37.9%)
|
457 (46.0%)
|
|
|
TNM staging
|
|
|
0.614
|
0.736
|
Ⅰ
|
13(8.5%)
|
70(7.0%)
|
|
|
Ⅱ
|
56(36.6%)
|
388(39.0%)
|
|
|
Ⅲ
|
84(54.9%)
|
536(53.9%)
|
|
|
Tumor differentiation
|
|
|
2.042
|
0.360
|
Well
|
72(47.1%)
|
413(41.5%)
|
|
|
Moderate
|
32(20.9%)
|
208(20.9%)
|
|
|
Low
|
49(32.0%)
|
373(37.5%)
|
|
|
BMI
|
|
|
4.273
|
0.044﹡
|
≥25kg/m2
|
41(26.8%)
|
351(35.3%)
|
|
|
<25kg/m2
|
112(73.2%)
|
643(64.7%)
|
|
|
Statistically significant at level p<0.05. ﹡p<0.05, ﹡﹡p<0.01
HUA hyperuricemia, UA uric acid, BMI body mass index.
Effect of HUA on postoperative complications of Dixon for rectal cancer
Table 2 shows the common postoperative complications. In terms of intestinal obstruction, respiratory tract infection, deep vein thrombosis and urinary tract infection, there is no significant difference between HUA group and UA group. There were 148 cases (14.9%) of AL in UA group and 37 cases (24.2%) in HUA group, with significant difference (P = 0.006).
Table 2. Effect of HUA on postoperative complications of Dixon for rectal cancer
Postoperative complication
|
HUA(n=153)
|
UA(n=994)
|
χ2
|
P
|
AL
|
|
|
8.466
|
0.006﹡﹡
|
Yes
|
37(24.2%)
|
148(14.9%)
|
|
|
No
|
116(75.8%)
|
846(85.1%)
|
|
|
Ileus
|
|
|
2.460
|
0.128
|
Yes
|
27(17.6%)
|
129(13.0%)
|
|
|
No
|
126(82.4%)
|
865 (87.0%)
|
|
|
Respiratory infection
|
|
|
2.752
|
0.101
|
Yes
|
32(20.9%)
|
155(15.6%)
|
|
|
No
|
121(79.1%)
|
839(84.4%)
|
|
|
Deep venous thrombosis
|
|
|
1.591
|
0.232
|
Yes
|
8(5.2%)
|
31(3.1%)
|
|
|
No
|
145(94.8%)
|
963(96.9%)
|
|
|
Urinary tract infection
|
|
|
0.477
|
0.489
|
Yes
|
29(19.0%)
|
166(16.7%)
|
|
|
No
|
124(81.0%)
|
828(83.3%)
|
|
|
Statistically significant at level p<0.05.﹡﹡p<0.01
HUA hyperuricemia, UA uric acid, AL anastomotic leakage.
Role of HUA on AL in Dixon operation for rectal cancer
In Table 3, the relationship between HUA and AL of Dixon operation for rectal cancer was further discussed. It was found that age, gender, TNM stage, histological differentiation, BMI, surgical method and protective stoma had no significant effect on AL, while HUA (P = 0.006), Tumor distance from the anal margin (TD) (P = 0.024), PCT (P = 0.040) had significant differences on AL. In Table 4, logistic regression analysis showed that HUA (P = 0.021, OR 1.823, 95% CI, 1.079-2.519) and TD (P = 0.014, OR 0.669, 95% CI, 0.463-0.917) had significant difference on AL, while PCT (P = 0.060, OR 1.687, 95% CI, 0.981-2.630) had no significant difference.
Table 3. Role of HUA on AL in Dixon operation for rectal cancer
Characteristics
|
AL(n=185)
|
NAL(n=962)
|
χ2
|
P
|
Age
|
|
|
0.438
|
0.516
|
>60
|
81(43.8%)
|
396(41.2%)
|
|
|
≤60
|
104(56.2%)
|
566(58.8%)
|
|
|
Gender
|
|
|
0.527
|
0.517
|
Male
|
109(58.9%)
|
539(56.0%)
|
|
|
Female
|
76(41.1%)
|
423(44.0%)
|
|
|
HUA
|
|
|
8.466
|
0.006﹡﹡
|
Yes
|
37(20.0%)
|
116(12.1%)
|
|
|
No
|
148(80.0%)
|
846(87.9%)
|
|
|
TNM staging
|
|
|
0.981
|
0.612
|
Ⅰ
|
15(8.1%)
|
68(7.1%)
|
|
|
Ⅱ
|
76(41.1%)
|
368(38.2%)
|
|
|
Ⅲ
|
94(50.8%)
|
526(54.7%)
|
|
|
Tumor differentiation
|
|
|
2.635
|
0.268
|
Well
|
87(47.0%)
|
398(41.4%)
|
|
|
Moderate
|
32(17.3%)
|
208(21.6%)
|
|
|
Low
|
66(35.7%)
|
356(37.0%)
|
|
|
TD
|
|
|
5.523
|
0.024﹡
|
<7cm
|
63(34.1%)
|
247(25.7%)
|
|
|
≥7cm
|
122(65.9%)
|
715(74.3%)
|
|
|
BMI
|
|
|
2.438
|
0.128
|
≥25kg/m2
|
54(29.2%)
|
338(35.1%)
|
|
|
<25kg/m2
|
131(70.8%)
|
624(64.9%)
|
|
|
PCT
|
|
|
4.834
|
0.040﹡
|
Yes
|
26(14.1%)
|
85(8.8%)
|
|
|
No
|
159(85.9%)
|
877(91.2%)
|
|
|
Laparoscopic surgery
|
|
|
1.525
|
0.240
|
Yes
|
128(69.2%)
|
708(73.6%)
|
|
|
No
|
57(30.8%)
|
254(26.4%)
|
|
|
Preventive ostomy surgery
|
|
|
0.178
|
0.675
|
Yes
|
68(36.8%)
|
338(35.1%)
|
|
|
No
|
117(63.2%)
|
624(64.9%)
|
|
|
Statistically significant at level p<0.05. ﹡p<0.05, ﹡﹡p<0.01
HUA hyperuricemia, UA uric acid, AL anastomotic leakage, NAL non anastomotic leakage, TD tumor distance from the anal margin, BMI body mass index, PCT preoperative chemoradiotherapy.
Table 4. Logistic regression analysis for the relationship between HUA and AL of Dixon surgery for rectal cancer.
Characteristics
|
OR
|
95%CI
|
P
|
HUA
|
1.823
|
1.079-2.519
|
0.021﹡
|
TD
|
0.669
|
0.463-0.917
|
0.014﹡
|
PCT
|
1.687
|
0.981-2.630
|
0.060
|
Logistic regression. ﹡p<0.05
HUA hyperuricemia, TD tumor distance from the anal margin, PCT preoperative chemoradiotherapy.
Risk factors of AL in Dixon operation for rectal cancer patients with HUA
In Table 5, the risk factors of AL in patients with HUA undergoing Dixon operation were further analyzed. It was found that age, TNM stage, histological differentiation, TD, surgical method and protective stoma had no significant influence on AL, while gender (P = 0.035), BMI (P = 0.017) and PCT (P = 0.013) had significant differences. In Table 6, further logistic regression analysis showed that gender (P = 0.001, OR 0.410, 95% CI, 0.058-0.460), PCT (P = 0.004, OR 0.386, 95% CI, 0.093-0.642) had significant difference on AL, while BMI (P = 0.066, OR 2.949, 95% CI, 0.939-7.034) had no significant difference.
Table 5. Risk factors of AL in Dixon operation for rectal cancer patients with HUA.
Characteristics
|
AL(n=37)
|
NAL(n=116)
|
χ2
|
P
|
Age
|
|
|
0.209
|
0.706
|
>60
|
15(40.5%)
|
52(44.8%)
|
|
|
≤60
|
22(59.5%)
|
64(55.2%)
|
|
|
Gender
|
|
|
4.540
|
0.035﹡
|
Male
|
28(75.7%)
|
65(56.0%)
|
|
|
Female
|
9(24.3%)
|
51(44.0%)
|
|
|
BMI
|
|
|
6.682
|
0.017﹡
|
≥25kg/m2
|
13(35.1%)
|
18(15.5%)
|
|
|
<25kg/m2
|
24(64.9%)
|
98(84.5%)
|
|
|
TNM staging
|
|
|
1.249
|
0.535
|
Ⅰ
|
2(5.4%)
|
11(9.5%)
|
|
|
Ⅱ
|
16(43.2%)
|
40(34.5%)
|
|
|
Ⅲ
|
19(51.4%)
|
65(56.0%)
|
|
|
Tumor differentiation
|
|
|
0.791
|
0.673
|
Well
|
14(37.8%)
|
52(44.8%)
|
|
|
Moderate
|
11 (29.7%)
|
27(23.3%)
|
|
|
Low
|
12(32.4%)
|
37(31.9%)
|
|
|
TD
|
|
|
0.067
|
0.839
|
<7cm
|
12(32.4%)
|
35(30.1%)
|
|
|
≥7cm
|
25(67.6%)
|
81(69.8%)
|
|
|
PCT
|
|
|
6.204
|
0.013﹡
|
Yes
|
23(62.2%)
|
45(38.8%)
|
|
|
No
|
14(37.8%)
|
71(61.2%)
|
|
|
Laparoscopic surgery
|
|
|
0.819
|
0.434
|
Yes
|
26(70.3%)
|
72(62.1%)
|
|
|
No
|
11(29.7%)
|
44(37.9%)
|
|
|
Preventive ostomy surgery
|
|
|
0.938
|
0.415
|
Yes
|
9(24.3%)
|
38(32.8%)
|
|
|
No
|
28(75.7%)
|
78(67.2%)
|
|
|
Statistically significant at level p<0.05. ﹡p<0.05
HUA hyperuricemia, UA uric acid, AL anastomotic leakage, NAL non anastomotic leakage, TD tumor distance from the anal margin, BMI body mass index, PCT preoperative chemoradiotherapy.
Table 6. Logistic regression analysis for the relationship between risk factors of Dixon surgery and rectal cancer patients with HUA.
Characteristics
|
OR
|
95%CI
|
P
|
Gender
|
0.410
|
0.058-0.460
|
0.001﹡﹡
|
BMI
|
2.949
|
0.939-7.034
|
0.066
|
PCT
|
0.386
|
0.093-0.642
|
0.004﹡﹡
|
Logistic regression. ﹡﹡p<0.01
BMI body mass index, PCT preoperative chemoradiotherapy.