Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer: a retrospective study

Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer: a retrospective study Xue-Cong Zheng, Jin-Bo Su, Jin-Jie Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2183335/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Oct, 2023 Read the published version in BMC Gastroenterology → Version 1 posted 8 You are reading this latest preprint version Abstract Background The routine establishment of a diverting stoma (DS) remains controversial in every patient undergoing Dixon operation. We aimed to establish a model for the risk assessment of rectal anastomotic leak (RAREAL) after Dixon in non-emergency patients with rectal cancer, using routinely available variables, by which surgeons could individualize their approach to DS. Methods 413 patients who underwent Dixon operation for rectal cancer from January 2015 to December 2018 were taken as the model group for retrospective study. Univariate and multivariate logistic regression analysis was used to determine the independent risk factors associated with anastomotic leakage(AL). The area under the curve (AUC) of the receiver operating characteristic (ROC) and the Youden index were used to evaluate the RAREAL score. We constructed the RAREAL model. 191 patients who underwent Dixon operation due to rectal cancer from January 2019 to December 2020 were collected according to the uniform criteria as a validation group to validate the RAREAL model. The RAREAL score was performed on the patients in the modeling group, the ROC curve was used for analysis, and the Z test was used to evaluate the consistency of the ROC curve between the modeling group and the validation group. Results In the model group, multivariate analysis identified the following variables as independent risk factors for AL: HbA1c (odds ratio (OR) = 7.831; P = 0.004), Left colic artery (LCA) non preservation (OR = 7.035; P = 0.003), Tumor distance from the anal margin (TD) (OR = 14.246; P = 0.000). In the model group, the AUC of the ROC for evaluating AL with RAREAL was 0.764, and when RAREAL score = 4.5, its sensitivity, specificity and Youden index were 0.419, 0.995, 0.415, respectively. The AUC was 0.757 in the validation group and its sensitivity and specificity were 0.471 and 0.989, respectively, when RAREAL score = 4.5. Conclusion The RAREAL score can be used to assess the risk of AL after Dixon operation for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 4.5. Risk assessment of rectal anastomotic leak (RAREAL) Anastomotic leakage (AL) Rectal cancer DIXON Figures Figure 1 Figure 2 Figure 3 Background Low anterior resection with preservation of the anal sphincter (Dixon operation) is an increasingly common procedure for rectal cancer surgery. Anastomotic leakage (AL) is a major and serious surgical complication after anterior resection of rectal cancer, which continues to occur despite advances in surgical techniques and treatments. The reported incidence of AL in rectal surgery ranges from 3–19% [ 1 ]. AL is associated with prolonged hospital stay, increased medical costs, and higher morbidity and mortality in a short period of time. AL also promotes pelvic tumor recurrence and reduces overall survival [ 2 ]. Given the serious consequences of AL, most surgeons prefer prophylactic diverting stoma (DS) for high-risk patients with AL. But many of them may not develop AL even without a prophylactic DS, which would put the patient at risk of DS related complications and second surgical closure. Studies have shown that DS significantly delays postoperative recovery of patients. DS and stoma closure can lead to severe complications such as intestinal leak, ileus, intestinal perforation, intra-abdominal infection, disturbance of water electrolyte balance and renal dysfunction, as well as impair patient quality of life [ 3 , 4 ]. And there may be increased spending on health care funds in these situations, which surgeons need to consider carefully. Therefore, rapid and accurate prediction of AL assessment is essential for early treatment and DS in Dixon patients, while avoiding unnecessary invasive procedures in low-risk patients. Our aim was to identify preoperative and intraoperative risk factors using simple and commonly used variables. These risk factors were then used to establish a risk assessment of rectal anastomotic Leak (RAREAL) model after DIXON surgery for rectal cancer, which was used to assess the risk of developing AL. We used this risk assessment model to help surgeons decide whether to perform a protective DS when performing sphincter-preserving surgery for rectal cancer. Materials And Methods Patients and Study Design We retrieved the electronic medical records of the Second Affiliated Hospital of Fujian Medical University between January 2015 and December 2020, and selected the information of 721 hospitalized patients who had undergone Dixon surgery for rectal cancer who were hospitalized during this period. Exclusion criteria: patients with intestinal obstruction (47 cases), patients with rectal perforation (6 cases), patients with distant metastasis (38 cases), and patients with incomplete hospitalization data (26 cases). A total of 604 consecutive patients who had undergone DIXON for rectal cancer were screened and collected. Signed informed consent was obtained from all study subjects. This study was approved by the ethics committee of the Second Affiliated Hospital of Fujian Medical University (2022208). A total of 413 hospitalized patients who underwent Dixon surgery for rectal cancer from January 2015 to December 2018 were used as the modeling group, which were divided into NAL group (382 patients) and AL group (31 patients) according to whether AL occurred after surgery. A total of 191 hospitalized patients who underwent DIXON surgery for rectal cancer from January 2019 to December 2020 were selected as the validation group, including the NAL group (174 cases) and the AL group (17 cases) (Fig. 1 ). The investigated variables were age, gender, smoking, Alcohol excess, body mass index (BMI), history of malignant tumor, hypertension, preoperative chemoradiotherapy (PCT), diabetes mellitus, HbA1c (glycated hemoglobin), American Society of Anesthesiologists physical status classification (ASA ), operation time, intraoperative blood loss, left colic artery (LCA) preservation, tumor distance from the anal margin (TD), number of staples, surgical approach, DS, pathological T stage, pathological N stage, TNM stage, and tumor histological differentiation. All surgeries were performed by experienced and skilled colorectal surgeons. Routine bowel preparation was performed before surgery, and the principles of total mesorectal excision (TME) were strictly followed for both open and laparoscopic procedures. For transection and anastomosis of the rectum, linear cutting closure device was used for rectal resection, and circular stapler was used for rectal anastomosis. After anastomosis, the pelvic cavity and abdominal cavity were irrigated with a large amount of distilled water to clean, and a rubber drain was routinely left in place next to the rectal anastomosis in the pelvic cavity. All patients received active preoperative preparation. Hypertension, hyperglycemia, hypoalbuminemia, anemia, and water-electrolyte imbalances were corrected before surgery. All patients received adequate nutrition, anti-infection and other symptomatic treatment after operation. Definition Of Al Clinical diagnostic criteria for AL[ 5 ]: clinical signs of AL were considered if the pelvic drain was draining pus or stool and there were suspicious symptoms of peritonitis, including abdominal pain, tenderness, fever, tachycardia, or severe inflammation on blood tests. AL was further confirmed by CT scan or colonoscopy. Positive CT scan: abscess and effusion or air bubbles around the anastomosis; Positive colonoscopy: the rectal cavity communicates with the extracavity (Fig. 2 ). Enema with contrast agent was not routinely performed in our department, and asymptomatic AL was not considered. All rectal cancers were confirmed as primary rectal adenocarcinomas by preoperative colonoscopy as well as postoperative pathology. Statistical analysis Statistical analysis was performed using SPSS 21.0 software. Normally distributed measurement data are represented by \(\stackrel{-}{x}\pm s\) ,an, skewed distribution data are represented by median (upper and lower quartiles) [M (P25, P75)]. Enumeration data were expressed as the number of cases (%). The t test, χ²test and Mann-Whitney U test were used for statistical analysis of the two groups of data in the NAL group and the AL group. Multivariate Logistic regression analysis was used to obtain the risk factors of the AL group, and the partial regression coefficient was rounded into the score of the corresponding risk factor index. Risk assessment of rectal anastomotic leak (RAREAL) score was used to express the risk of AL group. The area under the curve (AUC) of the receiver operating characteristic (ROC) and the Youden index were used to evaluate the RAREAL score. The maximum Youden index obtained corresponds to the sensitivity and specificity of RAREAL. The RAREAL score was performed on the patients in the modeling group, the ROC curve was used for analysis, and the Z test was used to evaluate the consistency of the ROC curve between the modeling group and the validation group. P <0.05 was considered to be statistically significant. Result Analysis of clinical data A total of 604 patients who underwent DIXON surgery for rectal cancer were retrospectively collected. The incidence of AL was 7.9% (48/604), of which the incidence of AL in the model group and AL in the validation group were 7.5% (31/413) and 8.9% (17/191), respectively. Analysis Of Patient Related Factors In The Model Group Compared with the NAL group, there were more male patients ( P = 0.008) and PCT ( P = 0.034) in the AL group. Patients with HbA1c (> 6.3%) also had significantly higher AL after surgery ( P = 0.036). There was no significant difference in age, smoking, Alcohol excess, BMI, history of malignant tumor, Diabetes mellitus, hypertension and ASA between AL group and NAL group. Analysis Of Surgical Related Factors In Model Group There were more patients with LCA non preservation ( P = 0.044) and with more than 2 staples ( P = 0.008) in the AL group compared with the NAL group. There was no significant difference in operation time, intraoperative blood loss, surgical approach and DS between the AL group and the NAL group. Analysis Of Tumor Related Factors In The Model Group Compared with the NAL group, the AL group had more patients with TD (< 7cm) ( P = 0.000). There was no significant difference in pathological T stage, pathological N stage, TNM stage and tumor histological differentiation. The clinical information and results of the univariate analysis of the patients in the model group are shown in Table 1 Information For Validation Group The incidence of AL in 191 patients undergoing DIXON surgery for rectal cancer was 8.9% (17/191). Patients with TD (< 7cm) were 50.8% (97/191) which was slightly higher than 48.9% (202/413) of the model group. Patients with DS were 21.5% (41/191) which was slightly lower than 21.8% (90/413) of the model group. Among them, there are 174 cases of NAL and 17 cases of AL. The information of the patients in the validation group was shown in the Table 2 . Construction Of Rareal Model Transformations that convert continuous variables to categorical variables For the convenience of constructing the RAREAL model, the glycated hemoglobin (HbA1c) variable, which is a continuous variable, was converted into a dichotomous variable (> 6.3%, ≤ 6.3%)[> 45mmol/mol,≤45mmol/mol] according to the clinical test reference range of HbA1c (3.9%-6.3%)[30 mmol/mol − 45mmol/mol] . Model Building AL after DIXON operation for rectal cancer was used as the dependent variable, and age, gender, smoking, alcohol excess, BMI, history of malignant tumor, hypertension, PCT, diabetes mellitus, HbA1c, ASA, operation time, intraoperative blood loss, LCA preservation, number of staples, surgical approach, DS, TD, pathological T stage, pathological N stage, TNM stage, and tumor histological differentiation were used as independent variables. Univariate analysis showed that male ( P = 0.008), HbA1c (> 6.3%) ( P = 0.036), PCT (P = 0.034), LCA non preservation ( P = 0.044), TD ( 6.3%) (odds ratio (OR) 7.831; 95% confidence interval (CI) 1.943–31.557; P = 0.004), LCA non preservation (OR 7.035; 95% CI1.968-25.142; P = 0.003), TD ( 6.3%), X2: LCA non preservation, X3: TD (< 7cm)). The partial regression coefficients of the equation were 2.058, 1.951, and 2.656, respectively. The partial regression coefficients were rounded to the corresponding scores of the indicators to establish the RAREAL model for AL. The score for HbA1c (> 6.3%) was 2, for LCA non preservation was 2, and for TD (< 7cm) was 3. Diagnostic effect of RAREAL model analyzed by ROC curve and comparison of ROC curve of two groups When the maximum Youden index of the model group was 0.415, the corresponding best cut-off point of RAREAL was 4.5, the AUC (95%CI) was 0.764 (0.660–0.868), and its diagnostic sensitivity and specificity were 0.419, 0.995. When the RAREAL score was 4.5 as the diagnostic cutoff in the validation group, the AUC (95%CI) was 0.757 (0.610–0.904), and its corresponding sensitivity and specificity were 0.471 and 0.989, respectively. There was no significant difference in the AUC of the ROC between the two groups (P = 0.939) (Table 4 ) Factors AL (n = 31) NAL (n = 382) P Table 1 characteristics of patients in the model group Patient related factors Age(years, \(\stackrel{-}{x}\pm s\) ) 60.6 ± 8.4 59.8 ± 11.9 0.624 Gender, n = No (%) 0.008 Female 4(12.9%) 139(36.4%) Male 27(87.1%) 243(63.6%) Smoking, n = No (%) 0.556 Yes 12(38.7%) 128(33.5%) No 19(61.3%) 254(66.5%) Alcohol excess, n = No (%) 0.796 Yes 10(32.3%) 132(34.6%) No 21(67.7%) 250(65.4%) History of malignant tumor, n = No (%) 0.821 Yes 28(90.3%) 340(89.0%) No 3(9.7%) 42(11.0%) BMI(kg/m 2 , \(\stackrel{-}{x}\pm s\) ) 22.3 ± 2.1 22.6 ± 2.7 0.503 HbA1c, n = No (%) 0.036 ≤ 6.3% 26(83.9%) 361(94.5%) > 6.3% 5(16.1%) 21(5.5%) Diabetes mellitus, n = No (%) 0.861 Yes 6(19.4%) 79(20.7%) No 25(80.6%) 303(79.3%) Hypertension, n = No (%) 0.404 Yes 20(64.5%) 217(56.8%) No 11(35.5%) 165(43.2%) PCT, n = No (%) 0.034 Yes 9(29.0%) 53(13.9%) No 22(71.0%) 329(86.1%) ASA grade, n = No (%) 0.224 3 4(12.9%) 45(11.8%) 2 8(25.8%) 146(38.2%) 1 19(61.3%) 191(50.0%) Surgical related factors Operation time(min) 0.734 Median(IQR) 180(160, 210) 180(165, 211) Intraoperative blood loss (ml) 0.739 Median(IQR) 40 (30,70) 40 (40,50) LCA preservation, n = No (%) 0.044 Yes 23(74.2%) 337(88.2%) No 8(25.8%) 45(11.8%) Number of staples fired, n = No (%) 0.008 1 or 2 20(64.5%) 319(83.5%) ༞2 11(35.5%) 63(16.5%) Surgical approach, n = No (%) 0.199 Laparoscopic 24(77.4%) 326(85.7%) Open 7(22.6%) 56(14.3%) Diverting stoma, n = No (%) 0.427 Yes 5(16.1%) 85(22.3%) No 26(83.9%) 297(77.7%) Tumor related factors TD, n = No (%) 0.000 ≥ 7cm 5(16.1%) 206(53.9%) < 7cm 26(83.9%) 176(46.1%) Pathological T stage, n = No (%) 0.145 Tis, T1, T2, 8(25.8%) 149(39.0%) T3 and T4 23(74.2%) 233(61.0%) Pathological N stage, n = No (%) 0.312 N0 6(19.4%) 106(27.7%) N1 and N2 25(80.6%) 276(72.3%) TNM stage, n = No (%) 0.303 Ⅰ 4(12.9%) 43(11.3%) Ⅱ 8(25.8%) 152(39.8%) Ⅲ 19(61.3%) 187(49.0%) Tumor histological differentiation, n = No (%) 0.473 High 14(45.2%) 173(45.3%) Moderate 11(35.5%) 103(27.0%) Low 6(19.4%) 106(27.7%) AL anastomotic leakage, NAL non anastomotic leakage, BMI body mass index, HbA1c glycated hemoglobin, PCT preoperative chemoradiotherapy, ASA American Society of Anesthesiologists physical status classification, IQR interquartile range, LCA left colic artery, TD tumor distance from the anal margin. Factors AL(n = 17) NAL(n = 174) P Table 2 characteristics of patients in the validation group Patient related factors Age(years, \(\stackrel{-}{x}\pm s\) ) 59.0 ± 9.2 57.4 ± 12.2 0.594 Gender, n = No (%) 0.097 Female 3(17.6%) 66(37.9%) Male 14(82.4%) 108(62.1%) Smoking, n = No (%) 0.867 Yes 6(35.3%) 65(37.4%) No 11(64.7%) 109(62.6%) Alcohol excess, n = No (%) 0.488 Yes 5(29.4%) 66(37.9%) No 12(70.6%) 108(62.1%) History of malignant tumor, n = No (%) 0.446 Yes 1(5.9%) 21(12.1%) No 16(94.1%) 153(87.9%) BMI(kg/m 2 , \(\stackrel{-}{x}\pm s\) ) 23.2 ± 1.8 23.9 ± 2.2 0.253 HbA1c, n = No (%) 0.096 ≤ 6.3% 14(82.4%) 164(94.3%) > 6.3% 3(17.6%) 10(5.7%) Diabetes mellitus, n = No (%) 0.916 Yes 4(23.5%) 39(22.4%) No 13(76.5%) 135(77.6%) Hypertension, n = No (%) 0.793 Yes 7(41.2%) 66(37.9%) No 10(58.8%) 108(62.1%) PCT, n = No (%) 0.170 Yes 5(29.4%) 27(15.5%) No 12(70.6%) 147(84.5%) ASA grade, n = No (%) 0.958 3 2(11.8%) 23(13.2%) 2 5(29.4%) 55(31.6%) 1 10(58.8%) 96(55.2%) Surgical related factors Operation time (min) 0.682 Median(IQR) 180(172.50,210) 180(165,215) Intraoperative blood loss (ml) 0.810 Median(IQR) 40(25,90) 40(40,50) LCA preservation, n = No (%) 0.071 Yes 12(70.6%) 152(87.4%) No 5(29.4%) 22(12.6%) Number of staples fired, n = No (%) 0.872 1 or 2 13(76.5%) 136(78.2%) ༞2 4(23.5%) 38(21.8%) Surgical approach, n = No (%) 0.454 Laparoscopic 14(82.4%) 153(87.9%) Open 3(17.6%) 21(12.1%) Diverting stoma, n = No (%) 0.535 Yes 2(11.8%) 39(22.4%) No 15(88.2%) 135(77.6%) Tumor related factors TD, n = No (%) 0.006 ≥ 7cm 3(17.6%) 91(52.3%) < 7cm 14(82.4%) 83(47.7%) Pathological T stage, n = No (%) 0.595 Tis, T1, T2, 6(35.3%) 73(42.0%) T3 and T4 11(64.7%) 101(58.0%) Pathological N stage, n = No (%) 0.403 N0 3(17.6%) 53(30.5%) N1 and N2 14(82.4%) 121(69.5%) TNM stage, n = No (%) 0.979 Ⅰ 2(11.8%) 19(10.9%) Ⅱ 8(47.1%) 79(45.4%) Ⅲ 7(41.2%) 76(43.7%) Tumor histological differentiation, n = No (%) 0.814 High 9(52.9%) 81(46.6%) Moderate 5(29.4%) 51(29.3%) Low 3(17.6%) 42(24.1%) AL anastomotic leakage, NAL non anastomotic leakage, BMI body mass index, HbA1c glycated hemoglobin, PCT preoperative chemoradiotherapy, ASA American Society of Anesthesiologists physical status classification, IQR interquartile range, LCA left colic artery, TD tumor distance from the anal margin. Factor B P值 OR 95% CI Table 3 Multivariate logistic regression analysis. Male 0.624 0.292 1.866 0.584–5.955 HbA1c (> 6.3%) 2.058 0.004 7.831 1.943–31.557 PCT 0.506 0.363 1.659 0.557–4.939 LCA non preservation 1.951 0.003 7.035 1.968–25.142 TD 2.656 0.000 14.246 3.504–57.913 Number of staples fired -0.784 0.118 0.456 0.171–1.220 HbA1c glycated hemoglobin, PCT preoperative chemoradiotherapy, LCA left colic artery, TD tumor distance from the anal margin. Group Youden index Best cut-off point AUC (95%CI) Sensitivity Specificity SE Z P Table 4 Evaluation of the consistency of ROC curve between the model group and the validation group Model group 0.415 4.5 0.764(0.660–0.868) 0.419 0.995 0.053 Validation group 0.757(0.610–0.904) 0.471 0.989 0.075 0.076 0.939 SE standard error Discussion AL is a major and serious surgical complication after anterior resection of rectal cancer。Many previous clinical studies have investigated many potential risk factors for AL after colorectal cancer surgery, including multiple perioperative factors [ 1 , 6 – 8 ]; combined with relevant risk factors, a variety of predictive models for AL after colorectal cancer surgery have been established [ 9 – 12 ]; however, the weights used in their reported models were different, and emergency factors were taken into account in many studies. To date, no accurate risk prediction model for AL after anterior rectal resection has been established. Emergency patients did not have sufficient time to correct risk factors such as anemia, hypoalbuminemia, diabetes, hypertension, and water and electrolyte disturbances. Due to the hasty preoperative preparation in emergency patients, the intestinal preparation would be poor, and the intestinal pollution would be more serious. Due to the intestinal dilation and the intestinal wall edema, the difficulty of intraoperative surgical procedures and dissection in emergency patients would also increase. All these factors also had a greater impact on intraoperative risk factors. These factors would also have a negative impact on cardiopulmonary function, and there would be more chances of postoperative cardiopulmonary complications, inflammatory storm, postoperative complications and AL. Many risk factors would have sufficient time to be corrected and improved in non-emergency limited-term surgery patients. For non-emergency patients with limited-term surgery, if these preoperative correctable risk factors were included in the analysis and prediction, the model construction may be biased and the performance of the model would be adversely affected, and the findings of these studies have not been further validated in other cohorts. The patients in our study were all non-emergency surgical patients at a restricted period, with sufficient time to complete relevant preoperative tests and correct comorbidities such as hypoalbuminemia, anemia, hypertension, and hyperglycemia preoperatively, with better adjustment of the cardiopulmonary function. The study of postoperative factors affecting AL may be more real and reasonable. Patient related factors: In our study, male, PCT, and HbA1c (> 6.3%) all were risk factors for postoperative AL. Male was a risk factor for AL, possibly due to the narrower and more complex anatomy of the male pelvis, which increased the difficulty of operation and transection of the rectal bowel [ 8 ] [ 13 ]. For patients with locally advanced rectal cancer, neoadjuvant therapy has been recognized as an important treatment modality to improve clinical outcomes. Previous studies have shown that PCT generally increases infection of the perineum and perineal wounds and prolongs anastomotic healing, possibly due to compromised immune systems that fight infection and tumor immunity. In addition, PCT usually caused inflammation and edema of the anastomosis, resulting in relative anastomotic ischemia, local inflammation and tissue fibrosis, which was not conducive to anastomotic healing, increases the risk of postoperative wound infection and pelvic abscess, and increases the incidence of AL [ 14 ]. The incidence of complications and mortality after major surgery in diabetic patients were significantly higher than those in non-diabetic patients. Poor glycemic control was an important risk factor for postoperative complications in diabetic patients, especially in relation to the incidence of microvascular complications [ 15 ]. In our study, it was found that the Diabetes mellitus was not significantly related to AL after rectal cancer surgery, but high HbA1c was associated with the risk of rectal AL. Further multivariate analysis found that HbA1c (> 6.3%) was an independent risk factor for AL. HbA1c reflected average blood glucose over approximately 3 months and has strong predictive value for diabetic complications. Reducing HbA1c from 7–6% [53 mmol/mol to 42 mmol/mol] reduced microvascular complications of diabetes [ 16 ]. Tumor related factors and surgical related factors: In our study, it was found that LCA non preservation, low rectal cancer and more than two staples fired were the risk factors for AL. In many previous studies, the level of rectal anastomosis has been considered a risk factor for AL [ 17 ], and low rectal cancer was found to be an independent risk factor in the present study. Low rectal cancer meant that the distance from the anus of the anastomosis was less than 5cm intraoperatively and the difficulty of performing rectal transection and rectal anastomotic techniques increased, in addition, a reduced level of anastomosis could also lead to a reduced blood supply to the anastomosis. In our study, intraoperative LCA non preservation was clearly associated with AL and was an independent risk factor. The blood supply of the anastomosis was of great importance to prevent the occurrence of AL, which has become a consensus that therapeutic surgery preserving LCA could improve the blood supply of the anastomosis and reduce the complications of the anastomosis [ 18 ] [ 19 ]. Intraoperative more than 2 staples were found to be a risk factor for AL in this study. Rectal cancer surgery was generally more difficult than colon cancer surgery. Because of the poor surgical field of view and the limited operating space of the pelvic cavity, the angle of cleavage of linear stapler cut was not well adjusted during surgery, which increased the difficulty of rectal transection, especially when low rectal resections were performed, often requiring more linear stapler. An increased number of linear staplers might cause small defects between the staples, while excessive pressing of the tissue was bound to cause local endothelial damage and secondary thrombosis affecting the local blood supply, leading to complications such as AL [ 7 ] [ 20 ]. Based on our results, a scoring model for the RAREAL (Risk Assessment of REctal Anastomotic Leak) was developed. The score for high HbA1c was 2, for LCA non preservation was 2, and for low rectal cancer was 3. The AUC of the RAREAL model was 0.764, its diagnostic sensitivity and specificity were 41.9% and 99.5%, respectively, and the AUC of the validation group was 0.757, its diagnostic sensitivity was 47.1% and specificity was 98.9%. the AUC of the ROC of the two groups was not significantly different (P = 0.939), indicating the good predictive function of the RAREAL model. During DIXON operation for rectal cancer, the RAREAL score can be performed. If the score is more than 4.5, the possibility of postoperative AL is high. If AL occurs after rectal cancer surgery in a patient, DS can protect the patient from complications such as sepsis. But the cost of DS is many DS related complications, the huge risk of possible DS related emergency surgery, and the decline in the quality of life after the DS. the DS should be determined according to the specific situation of each patient. Especially when new situations arise during surgery that do not match preoperative predictions, the DS or not, is sometimes a difficult option for the surgeon. The RAREAL model is a relatively simple and easy to master, established a score of 4.5 as a reference for clinicians and surgeons. If the score is more than 4.5, preventive DS should be performed to avoid severe postoperative infection. The variables used in RAREAL, which are simple and easy to use, are also familiar to clinicians, and this model facilitates surgeons to make rapid and correct judgments. This model may obviate the need for the DS in patients with a low risk of AL, helping to achieve a more rational allocation of healthcare resources, thus improving patient quality of life and reducing financial burden on patients. Our study had the following limitations, first, the retrospective nature of our study not only made bias from patient selection and data collection difficult to avoid, but its nonrandomized study design made it impossible to control or correct for each bias in this study design. Second, the limited number of patients in the AL group in our report might hinder the discovery of more other risk factors for AL in our study. Conclusion In conclusion, the RAREAL score can be used to assess the risk of AL after Dixon surgery for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 4.5. Abbreviations RAREAL Risk assessment of rectal anastomotic leak AL Anastomotic leakage NAL Non anastomotic leakage HbA1c Glycated hemoglobin DS Diverting stoma LCA Left colic artery, TD Tumor distance from the anal margin PCT Preoperative chemoradiotherapy ASA American Society of Anesthesiologists physical status classification IQR Interquartile range BMI Body mass index AUC Area under the curve ROC Receiver operating characteristic SE Standard error Declarations Acknowledgements None Author contributions XC Z and JB S designed the study; XC Z conducted main literature search and wrote the first draft of the paper. JB S contributed to analytical design, data analysis and revision of the manuscript. XC Z and JB S contributed equally to this work and should be considered co-first authors. JJ Z contributed to main literature search, data analysis. All authors read and approved the final manuscript. Funding No financial support was provided for this study. Availability of data and materials Correspondence and requests for materials should be addressed to X.C.Z on reasonable request. Ethics approval and consent to participate The present study was conducted in accordance with the World Medical Association Declaration of Helsinki. Written informed consent was obtained from all participants included in the study. The Ethics Committee of the Second Affiliated Hospital of Fujian Medical University gave the ethics approval for this retrospective study (2022208). Consent for publication Patients signed informed consent regarding publishing their data. Conflict of interest All authors declare that they have no conflict of interest. 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Watanabe T, Miyata H, Konno H, Kawai K, Ishihara S, Sunami E, Hirahara N, Wakabayashi G, Gotoh M, Mori M: Prediction model for complications after low anterior resection based on data from 33,411 Japanese patients included in the National Clinical Database . Surgery 2017, 161 (6):1597-1608. Arezzo A, Migliore M, Chiaro P, Arolfo S, Filippini C, Di Cuonzo D, Cirocchi R, Morino M, Collaborators RS: The REAL (REctal Anastomotic Leak) score for prediction of anastomotic leak after rectal cancer surgery . Tech Coloproctol 2019, 23 (7):649-663. Zheng H, Wu Z, Wu Y, Mo S, Dai W, Liu F, Xu Y, Cai S: Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer . Int J Colorectal Dis 2019, 34 (2):319-328. Hoshino N, Hida K, Sakai Y, Osada S, Idani H, Sato T, Takii Y, Bando H, Shiomi A, Saito N: Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer . Int J Colorectal Dis 2018, 33 (4):411-418. Zarnescu EC, Zarnescu NO, Costea R: Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery . Diagnostics (Basel) 2021, 11 (12). Yang J, Luo Y, Tian T, Dong P, Fu Z: Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis . J Oncol 2022, 2022 :8197701. Kim KJ, Choi J, Bae JH, Kim KJ, Yoo HJ, Seo JA, Kim NH, Choi KM, Baik SH, Kim SG et al : Time to Reach Target Glycosylated Hemoglobin Is Associated with Long-Term Durable Glycemic Control and Risk of Diabetic Complications in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A 6-Year Observational Study . Diabetes Metab J 2021, 45 (3):368-378. American Diabetes A: 6. Glycemic Targets . Diabetes Care 2017, 40 (Suppl 1):S48-S56. Fukada M, Matsuhashi N, Takahashi T, Imai H, Tanaka Y, Yamaguchi K, Yoshida K: Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer . World J Surg Oncol 2019, 17 (1):178. Fan YC, Ning FL, Zhang CD, Dai DQ: Preservation versus non-preservation of left colic artery in sigmoid and rectal cancer surgery: A meta-analysis . Int J Surg 2018, 52 :269-277. Yang X, Ma P, Zhang X, Wei M, He Y, Gu C, Deng X, Wang Z: Preservation versus non-preservation of left colic artery in colorectal cancer surgery: An updated systematic review and meta-analysis . Medicine (Baltimore) 2019, 98 (5):e13720. Balciscueta Z, Uribe N, Caubet L, Lopez M, Torrijo I, Tabet J, Martin MC: Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis . Tech Coloproctol 2020, 24 (9):919-925. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Oct, 2023 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Major revision 28 Nov, 2022 Reviews received at journal 25 Oct, 2022 Reviewers agreed at journal 20 Oct, 2022 Reviewers invited by journal 20 Oct, 2022 Editor assigned by journal 20 Oct, 2022 Editor invited by journal 20 Oct, 2022 Submission checks completed at journal 20 Oct, 2022 First submitted to journal 19 Oct, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2183335","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":145745770,"identity":"c8a7f480-ca75-47ec-b8de-1c062a88f3a2","order_by":0,"name":"Xue-Cong Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYHAC9h8fKv7x2Lc3PjAA8w8QoUdyxpkDcgY8hw2I1yLN23bA2EAiGaKDoBb5GckPDGe23UncLvmYoehmG4Mc340Exs8FeLQw9hwzSPhw7lniztnJDMa5bQzGkjcSmKVn4NHCzN7DcHBGGXNiw+38AyAtiRtuJLAx8+DRApRlbOZhA2q5eRhsSz1BLTzsPczMPG2HjQ1uMIO1JBgQ0iLBc8yMccaZNDnJHqBfcs5JGM4887BZGp8WYIg9Y/hQYcPDz36YzTinzEae73jywc/4tKD4CxgxEkCasYFIDcDQe0C00lEwCkbBKBhRAADqIExQrn0ewgAAAABJRU5ErkJggg==","orcid":"","institution":"the Second Affiliated Hospital of Fujian Medical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xue-Cong","middleName":"","lastName":"Zheng","suffix":""},{"id":145745771,"identity":"23a7ed0b-524e-47fb-9e27-98aef95f771a","order_by":1,"name":"Jin-Bo Su","email":"","orcid":"","institution":"Quanzhou First Hospital Affiliated to Fujian Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jin-Bo","middleName":"","lastName":"Su","suffix":""},{"id":145745772,"identity":"c25f54f7-2d92-44e1-9d1b-703880c96419","order_by":2,"name":"Jin-Jie Zheng","email":"","orcid":"","institution":"the Second Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jin-Jie","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2022-10-19 14:14:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2183335/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2183335/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-023-02982-2","type":"published","date":"2023-10-03T15:01:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":28290583,"identity":"e064ad9d-fff7-4c92-8b6a-0fb29ded6b0a","added_by":"auto","created_at":"2022-10-26 17:23:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":14332,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of experimental design in our study\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2183335/v1/3974e5296915ff7a847c20b8.png"},{"id":28290584,"identity":"e36fe4aa-9493-4319-90e1-3abd3c2a343f","added_by":"auto","created_at":"2022-10-26 17:23:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":424043,"visible":true,"origin":"","legend":"\u003cp\u003eImage of AL. (a) Computed tomography scan of the pelvis: air bubbles and fluid around the rectal anastomosis; (b) Colonoscopy: rectal anastomotic defect.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2183335/v1/b7084fa118c050c7722c0656.png"},{"id":28290972,"identity":"cf0da2d6-accc-423e-a5ff-0bf52eb29a81","added_by":"auto","created_at":"2022-10-26 17:28:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":164292,"visible":true,"origin":"","legend":"\u003cp\u003e(a) The ROC (AUC 0.764) for the diagnosis of AL with the RAREAL score in the modeling group; (b) The ROC (AUC 0.757) for the diagnosis of AL with the RAREAL score in the validation group\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-2183335/v1/784c06aac283b090365c9550.png"},{"id":44301922,"identity":"464db8cc-9539-460c-b056-952183d37415","added_by":"auto","created_at":"2023-10-09 15:08:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1457523,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2183335/v1/5fd50eee-d980-4496-a7fe-0b38a23d6b4a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer: a retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003eLow anterior resection with preservation of the anal sphincter (Dixon operation) is an increasingly common procedure for rectal cancer surgery. Anastomotic leakage (AL) is a major and serious surgical complication after anterior resection of rectal cancer, which continues to occur despite advances in surgical techniques and treatments. The reported incidence of AL in rectal surgery ranges from 3\u0026ndash;19% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. AL is associated with prolonged hospital stay, increased medical costs, and higher morbidity and mortality in a short period of time. AL also promotes pelvic tumor recurrence and reduces overall survival [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven the serious consequences of AL, most surgeons prefer prophylactic diverting stoma (DS) for high-risk patients with AL. But many of them may not develop AL even without a prophylactic DS, which would put the patient at risk of DS related complications and second surgical closure. Studies have shown that DS significantly delays postoperative recovery of patients. DS and stoma closure can lead to severe complications such as intestinal leak, ileus, intestinal perforation, intra-abdominal infection, disturbance of water electrolyte balance and renal dysfunction, as well as impair patient quality of life [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. And there may be increased spending on health care funds in these situations, which surgeons need to consider carefully.\u003c/p\u003e \u003cp\u003eTherefore, rapid and accurate prediction of AL assessment is essential for early treatment and DS in Dixon patients, while avoiding unnecessary invasive procedures in low-risk patients. Our aim was to identify preoperative and intraoperative risk factors using simple and commonly used variables. These risk factors were then used to establish a risk assessment of rectal anastomotic Leak (RAREAL) model after DIXON surgery for rectal cancer, which was used to assess the risk of developing AL. We used this risk assessment model to help surgeons decide whether to perform a protective DS when performing sphincter-preserving surgery for rectal cancer.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients and Study Design\u003c/h2\u003e \u003cp\u003eWe retrieved the electronic medical records of the Second Affiliated Hospital of Fujian Medical University between January 2015 and December 2020, and selected the information of 721 hospitalized patients who had undergone Dixon surgery for rectal cancer who were hospitalized during this period. Exclusion criteria: patients with intestinal obstruction (47 cases), patients with rectal perforation (6 cases), patients with distant metastasis (38 cases), and patients with incomplete hospitalization data (26 cases). A total of 604 consecutive patients who had undergone DIXON for rectal cancer were screened and collected. Signed informed consent was obtained from all study subjects. This study was approved by the ethics committee of the Second Affiliated Hospital of Fujian Medical University (2022208).\u003c/p\u003e \u003cp\u003eA total of 413 hospitalized patients who underwent Dixon surgery for rectal cancer from January 2015 to December 2018 were used as the modeling group, which were divided into NAL group (382 patients) and AL group (31 patients) according to whether AL occurred after surgery. A total of 191 hospitalized patients who underwent DIXON surgery for rectal cancer from January 2019 to December 2020 were selected as the validation group, including the NAL group (174 cases) and the AL group (17 cases) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe investigated variables were age, gender, smoking, Alcohol excess, body mass index (BMI), history of malignant tumor, hypertension, preoperative chemoradiotherapy (PCT), diabetes mellitus, HbA1c (glycated hemoglobin), American Society of Anesthesiologists physical status classification (ASA ), operation time, intraoperative blood loss, left colic artery (LCA) preservation, tumor distance from the anal margin (TD), number of staples, surgical approach, DS, pathological T stage, pathological N stage, TNM stage, and tumor histological differentiation.\u003c/p\u003e \u003cp\u003eAll surgeries were performed by experienced and skilled colorectal surgeons. Routine bowel preparation was performed before surgery, and the principles of total mesorectal excision (TME) were strictly followed for both open and laparoscopic procedures. For transection and anastomosis of the rectum, linear cutting closure device was used for rectal resection, and circular stapler was used for rectal anastomosis. After anastomosis, the pelvic cavity and abdominal cavity were irrigated with a large amount of distilled water to clean, and a rubber drain was routinely left in place next to the rectal anastomosis in the pelvic cavity.\u003c/p\u003e \u003cp\u003eAll patients received active preoperative preparation. Hypertension, hyperglycemia, hypoalbuminemia, anemia, and water-electrolyte imbalances were corrected before surgery. All patients received adequate nutrition, anti-infection and other symptomatic treatment after operation.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDefinition Of Al\u003c/h3\u003e\n\u003cp\u003eClinical diagnostic criteria for AL[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]: clinical signs of AL were considered if the pelvic drain was draining pus or stool and there were suspicious symptoms of peritonitis, including abdominal pain, tenderness, fever, tachycardia, or severe inflammation on blood tests. AL was further confirmed by CT scan or colonoscopy. Positive CT scan: abscess and effusion or air bubbles around the anastomosis; Positive colonoscopy: the rectal cavity communicates with the extracavity (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Enema with contrast agent was not routinely performed in our department, and asymptomatic AL was not considered. All rectal cancers were confirmed as primary rectal adenocarcinomas by preoperative colonoscopy as well as postoperative pathology.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using SPSS 21.0 software. Normally distributed measurement data are represented by \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm s\\)\u003c/span\u003e\u003c/span\u003e,an, skewed distribution data are represented by median (upper and lower quartiles) [M (P25, P75)]. Enumeration data were expressed as the number of cases (%). The t test, χ\u0026sup2;test and Mann-Whitney U test were used for statistical analysis of the two groups of data in the NAL group and the AL group. Multivariate Logistic regression analysis was used to obtain the risk factors of the AL group, and the partial regression coefficient was rounded into the score of the corresponding risk factor index. Risk assessment of rectal anastomotic leak (RAREAL) score was used to express the risk of AL group. The area under the curve (AUC) of the receiver operating characteristic (ROC) and the Youden index were used to evaluate the RAREAL score. The maximum Youden index obtained corresponds to the sensitivity and specificity of RAREAL. The RAREAL score was performed on the patients in the modeling group, the ROC curve was used for analysis, and the Z test was used to evaluate the consistency of the ROC curve between the modeling group and the validation group. \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003eAnalysis of clinical data\u003c/h2\u003e\n \u003cp\u003eA total of 604 patients who underwent DIXON surgery for rectal cancer were retrospectively collected. The incidence of AL was 7.9% (48/604), of which the incidence of AL in the model group and AL in the validation group were 7.5% (31/413) and 8.9% (17/191), respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eAnalysis Of Patient Related Factors In The Model Group\u003c/h3\u003e\n\u003cp\u003eCompared with the NAL group, there were more male patients (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) and PCT (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034) in the AL group. Patients with HbA1c (\u0026gt;\u0026thinsp;6.3%) also had significantly higher AL after surgery (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036). There was no significant difference in age, smoking, Alcohol excess, BMI, history of malignant tumor, Diabetes mellitus, hypertension and ASA between AL group and NAL group.\u003c/p\u003e\n\u003ch3\u003eAnalysis Of Surgical Related Factors In Model Group\u003c/h3\u003e\n\u003cp\u003eThere were more patients with LCA non preservation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044) and with more than 2 staples (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) in the AL group compared with the NAL group. There was no significant difference in operation time, intraoperative blood loss, surgical approach and DS between the AL group and the NAL group.\u003c/p\u003e\n\u003ch3\u003eAnalysis Of Tumor Related Factors In The Model Group\u003c/h3\u003e\n\u003cp\u003eCompared with the NAL group, the AL group had more patients with TD (\u0026lt;\u0026thinsp;7cm) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000). There was no significant difference in pathological T stage, pathological N stage, TNM stage and tumor histological differentiation.\u003c/p\u003e\n\u003cp\u003eThe clinical information and results of the univariate analysis of the patients in the model group are shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\n\u003ch3\u003eInformation For Validation Group\u003c/h3\u003e\n\u003cp\u003eThe incidence of AL in 191 patients undergoing DIXON surgery for rectal cancer was 8.9% (17/191). Patients with TD (\u0026lt;\u0026thinsp;7cm) were 50.8% (97/191) which was slightly higher than 48.9% (202/413) of the model group. Patients with DS were 21.5% (41/191) which was slightly lower than 21.8% (90/413) of the model group. Among them, there are 174 cases of NAL and 17 cases of AL. The information of the patients in the validation group was shown in the Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003eConstruction Of Rareal Model\u003c/h3\u003e\n\u003cdiv class=\"Section2\" id=\"Sec13\"\u003e\n \u003ch2\u003eTransformations that convert continuous variables to categorical variables\u003c/h2\u003e\n \u003cp\u003eFor the convenience of constructing the RAREAL model, the glycated hemoglobin (HbA1c) variable, which is a continuous variable, was converted into a dichotomous variable (\u0026gt;\u0026thinsp;6.3%, \u0026le;\u0026thinsp;6.3%)[\u0026gt;\u0026thinsp;45mmol/mol,\u0026le;45mmol/mol] according to the clinical test reference range of HbA1c (3.9%-6.3%)[30 mmol/mol \u0026minus;\u0026thinsp;45mmol/mol] .\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eModel Building\u003c/h3\u003e\n\u003cp\u003eAL after DIXON operation for rectal cancer was used as the dependent variable, and age, gender, smoking, alcohol excess, BMI, history of malignant tumor, hypertension, PCT, diabetes mellitus, HbA1c, ASA, operation time, intraoperative blood loss, LCA preservation, number of staples, surgical approach, DS, TD, pathological T stage, pathological N stage, TNM stage, and tumor histological differentiation were used as independent variables. Univariate analysis showed that male (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008), HbA1c (\u0026gt;\u0026thinsp;6.3%) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036), PCT (P\u0026thinsp;=\u0026thinsp;0.034), LCA non preservation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044), TD (\u0026lt;\u0026thinsp;7cm) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044) and more than 2 staples fired during surgery (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008) were risk factors for AL. Further logistic regression analysis found that HbA1c (\u0026gt;\u0026thinsp;6.3%) (odds ratio (OR) 7.831; 95% confidence interval (CI) 1.943\u0026ndash;31.557; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), LCA non preservation (OR 7.035; 95% CI1.968-25.142; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), TD (\u0026lt;\u0026thinsp;7cm) (OR 14.246; 95% CI 3.504\u0026ndash;57.913; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000) were independent of AL risk factors (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Multivariate equation: Y=-7.620\u0026thinsp;+\u0026thinsp;2.058X1\u0026thinsp;+\u0026thinsp;1.951X2\u0026thinsp;+\u0026thinsp;2.656X3 (Y: AL, X1: HbA1c (\u0026gt;\u0026thinsp;6.3%), X2: LCA non preservation, X3: TD (\u0026lt;\u0026thinsp;7cm)).\u003c/p\u003e\n\u003cp\u003eThe partial regression coefficients of the equation were 2.058, 1.951, and 2.656, respectively. The partial regression coefficients were rounded to the corresponding scores of the indicators to establish the RAREAL model for AL. The score for HbA1c (\u0026gt;\u0026thinsp;6.3%) was 2, for LCA non preservation was 2, and for TD (\u0026lt;\u0026thinsp;7cm) was 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic effect of RAREAL model analyzed by ROC curve and comparison of ROC curve of two groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen the maximum Youden index of the model group was 0.415, the corresponding best cut-off point of RAREAL was 4.5, the AUC (95%CI) was 0.764 (0.660\u0026ndash;0.868), and its diagnostic sensitivity and specificity were 0.419, 0.995. When the RAREAL score was 4.5 as the diagnostic cutoff in the validation group, the AUC (95%CI) was 0.757 (0.610\u0026ndash;0.904), and its corresponding sensitivity and specificity were 0.471 and 0.989, respectively. There was no significant difference in the AUC of the ROC between the two groups (P\u0026thinsp;=\u0026thinsp;0.939) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003eAL (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003eNAL (n\u0026thinsp;=\u0026thinsp;382)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003echaracteristics of patients in the model group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\" style=\"width: 57.058%;\"\u003e\n \u003cp\u003ePatient related factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eAge(years, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e60.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e59.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eGender, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e4(12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e139(36.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e27(87.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e243(63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eSmoking, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.556\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e12(38.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e128(33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e19(61.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e254(66.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eAlcohol excess, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e10(32.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e132(34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e21(67.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e250(65.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eHistory of malignant tumor, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e28(90.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e340(89.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 36.4627%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e3(9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e42(11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 1.0362%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e22.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e22.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eHbA1c, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e26(83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e361(94.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e5(16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e21(5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eDiabetes mellitus, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e6(19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e79(20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e25(80.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e303(79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eHypertension, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e20(64.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e217(56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e11(35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e165(43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003ePCT, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e9(29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e53(13.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e22(71.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e329(86.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eASA grade, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e4(12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e45(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e8(25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e146(38.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e19(61.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e191(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eSurgical related factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eOperation time(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.734\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e180(160, 210)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e180(165, 211)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eIntraoperative blood loss (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e40 (30,70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e40 (40,50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 36.4627%;\"\u003e\n \u003cp\u003eLCA preservation, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e23(74.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e337(88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e8(25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e45(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNumber of staples fired, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e1 or 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e20(64.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e319(83.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e༞2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e11(35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e63(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eSurgical approach, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eLaparoscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e24(77.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e326(85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e7(22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e56(14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eDiverting stoma, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e5(16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e85(22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e26(83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e297(77.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eTumor related factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eTD, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;7cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e5(16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e206(53.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;7cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e26(83.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e176(46.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003ePathological T stage, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eTis, T1, T2,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e8(25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e149(39.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eT3 and T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e23(74.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e233(61.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003ePathological N stage, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.312\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e6(19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e106(27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eN1 and N2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e25(80.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e276(72.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eTNM stage, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e4(12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e43(11.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e8(25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e152(39.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e19(61.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e187(49.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\" style=\"width: 36.4627%;\"\u003e\n \u003cp\u003eTumor histological differentiation, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\n \u003cp\u003e0.473\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e14(45.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e173(45.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e11(35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e103(27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 25.5822%;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 10.8805%;\"\u003e\n \u003cp\u003e6(19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 11.6577%;\"\u003e\n \u003cp\u003e106(27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 8.9376%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAL\u003c/em\u003e anastomotic leakage, \u003cem\u003eNAL\u003c/em\u003e non anastomotic leakage, \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eHbA1c\u003c/em\u003e glycated hemoglobin, \u003cem\u003ePCT\u003c/em\u003e preoperative chemoradiotherapy, \u003cem\u003eASA\u003c/em\u003e American Society of Anesthesiologists physical status classification, \u003cem\u003eIQR\u003c/em\u003e interquartile range, \u003cem\u003eLCA\u003c/em\u003e left colic artery, \u003cem\u003eTD\u003c/em\u003e tumor distance from the anal margin.\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactors\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAL(n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNAL(n\u0026thinsp;=\u0026thinsp;174)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003echaracteristics of patients in the validation group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003ePatient related factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(82.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108(62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoking, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.867\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(37.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109(62.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlcohol excess, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108(62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistory of malignant tumor, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(94.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153(87.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{x}\\pm s\\)\u003c/span\u003e\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHbA1c, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(82.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164(94.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes mellitus, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39(22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135(77.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108(62.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e147(84.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA grade, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55(31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(58.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96(55.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eSurgical related factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOperation time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180(172.50,210)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180(165,215)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntraoperative blood loss (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedian(IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40(25,90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40(40,50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLCA preservation, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(70.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e152(87.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of staples fired, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 or 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136(78.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e༞2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(23.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38(21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical approach, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaparoscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(82.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153(87.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiverting stoma, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39(22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135(77.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eTumor related factors\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTD, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;7cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91(52.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;7cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(82.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83(47.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePathological T stage, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.595\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTis, T1, T2,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73(42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eT3 and T4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101(58.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePathological N stage, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53(30.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN1 and N2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(82.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e121(69.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTNM stage, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79(45.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76(43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTumor histological differentiation, n\u0026thinsp;=\u0026thinsp;No (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81(46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(29.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51(29.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAL\u003c/em\u003e anastomotic leakage, \u003cem\u003eNAL\u003c/em\u003e non anastomotic leakage, \u003cem\u003eBMI\u003c/em\u003e body mass index, \u003cem\u003eHbA1c\u003c/em\u003e glycated hemoglobin, \u003cem\u003ePCT\u003c/em\u003e preoperative chemoradiotherapy, \u003cem\u003eASA\u003c/em\u003e American Society of Anesthesiologists physical status classification, \u003cem\u003eIQR\u003c/em\u003e interquartile range, \u003cem\u003eLCA\u003c/em\u003e left colic artery, \u003cem\u003eTD\u003c/em\u003etumor distance from the anal margin.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP值\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate logistic regression analysis.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.584\u0026ndash;5.955\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHbA1c (\u0026gt;\u0026thinsp;6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.943\u0026ndash;31.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.506\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.557\u0026ndash;4.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLCA non preservation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.968\u0026ndash;25.142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.504\u0026ndash;57.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of staples fired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.171\u0026ndash;1.220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eHbA1c\u003c/em\u003e glycated hemoglobin, \u003cem\u003ePCT\u003c/em\u003e preoperative chemoradiotherapy, \u003cem\u003eLCA\u003c/em\u003e left colic artery, \u003cem\u003eTD\u003c/em\u003etumor distance from the anal margin. \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 15.1934%;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 13.2596%;\"\u003e\n \u003cp\u003eYouden index\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eBest cut-off point\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAUC (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eZ\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eEvaluation of the consistency of ROC curve between the model group and the validation group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.1934%;\"\u003e\n \u003cp\u003eModel group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2596%;\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.764(0.660\u0026ndash;0.868)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.1934%;\"\u003e\n \u003cp\u003eValidation group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2596%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.757(0.610\u0026ndash;0.904)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.1934%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2596%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSE standard error\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAL is a major and serious surgical complication after anterior resection of rectal cancer。Many previous clinical studies have investigated many potential risk factors for AL after colorectal cancer surgery, including multiple perioperative factors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; combined with relevant risk factors, a variety of predictive models for AL after colorectal cancer surgery have been established [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; however, the weights used in their reported models were different, and emergency factors were taken into account in many studies. To date, no accurate risk prediction model for AL after anterior rectal resection has been established. Emergency patients did not have sufficient time to correct risk factors such as anemia, hypoalbuminemia, diabetes, hypertension, and water and electrolyte disturbances. Due to the hasty preoperative preparation in emergency patients, the intestinal preparation would be poor, and the intestinal pollution would be more serious. Due to the intestinal dilation and the intestinal wall edema, the difficulty of intraoperative surgical procedures and dissection in emergency patients would also increase. All these factors also had a greater impact on intraoperative risk factors. These factors would also have a negative impact on cardiopulmonary function, and there would be more chances of postoperative cardiopulmonary complications, inflammatory storm, postoperative complications and AL. Many risk factors would have sufficient time to be corrected and improved in non-emergency limited-term surgery patients. For non-emergency patients with limited-term surgery, if these preoperative correctable risk factors were included in the analysis and prediction, the model construction may be biased and the performance of the model would be adversely affected, and the findings of these studies have not been further validated in other cohorts.\u003c/p\u003e \u003cp\u003eThe patients in our study were all non-emergency surgical patients at a restricted period, with sufficient time to complete relevant preoperative tests and correct comorbidities such as hypoalbuminemia, anemia, hypertension, and hyperglycemia preoperatively, with better adjustment of the cardiopulmonary function. The study of postoperative factors affecting AL may be more real and reasonable.\u003c/p\u003e \u003cp\u003ePatient related factors: In our study, male, PCT, and HbA1c (\u0026gt;\u0026thinsp;6.3%) all were risk factors for postoperative AL. Male was a risk factor for AL, possibly due to the narrower and more complex anatomy of the male pelvis, which increased the difficulty of operation and transection of the rectal bowel [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. For patients with locally advanced rectal cancer, neoadjuvant therapy has been recognized as an important treatment modality to improve clinical outcomes. Previous studies have shown that PCT generally increases infection of the perineum and perineal wounds and prolongs anastomotic healing, possibly due to compromised immune systems that fight infection and tumor immunity. In addition, PCT usually caused inflammation and edema of the anastomosis, resulting in relative anastomotic ischemia, local inflammation and tissue fibrosis, which was not conducive to anastomotic healing, increases the risk of postoperative wound infection and pelvic abscess, and increases the incidence of AL [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The incidence of complications and mortality after major surgery in diabetic patients were significantly higher than those in non-diabetic patients. Poor glycemic control was an important risk factor for postoperative complications in diabetic patients, especially in relation to the incidence of microvascular complications [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In our study, it was found that the Diabetes mellitus was not significantly related to AL after rectal cancer surgery, but high HbA1c was associated with the risk of rectal AL. Further multivariate analysis found that HbA1c (\u0026gt;\u0026thinsp;6.3%) was an independent risk factor for AL. HbA1c reflected average blood glucose over approximately 3 months and has strong predictive value for diabetic complications. Reducing HbA1c from 7\u0026ndash;6% [53 mmol/mol to 42 mmol/mol] reduced microvascular complications of diabetes [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTumor related factors and surgical related factors: In our study, it was found that LCA non preservation, low rectal cancer and more than two staples fired were the risk factors for AL. In many previous studies, the level of rectal anastomosis has been considered a risk factor for AL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], and low rectal cancer was found to be an independent risk factor in the present study. Low rectal cancer meant that the distance from the anus of the anastomosis was less than 5cm intraoperatively and the difficulty of performing rectal transection and rectal anastomotic techniques increased, in addition, a reduced level of anastomosis could also lead to a reduced blood supply to the anastomosis. In our study, intraoperative LCA non preservation was clearly associated with AL and was an independent risk factor. The blood supply of the anastomosis was of great importance to prevent the occurrence of AL, which has become a consensus that therapeutic surgery preserving LCA could improve the blood supply of the anastomosis and reduce the complications of the anastomosis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Intraoperative more than 2 staples were found to be a risk factor for AL in this study. Rectal cancer surgery was generally more difficult than colon cancer surgery. Because of the poor surgical field of view and the limited operating space of the pelvic cavity, the angle of cleavage of linear stapler cut was not well adjusted during surgery, which increased the difficulty of rectal transection, especially when low rectal resections were performed, often requiring more linear stapler. An increased number of linear staplers might cause small defects between the staples, while excessive pressing of the tissue was bound to cause local endothelial damage and secondary thrombosis affecting the local blood supply, leading to complications such as AL [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on our results, a scoring model for the RAREAL (Risk Assessment of REctal Anastomotic Leak) was developed. The score for high HbA1c was 2, for LCA non preservation was 2, and for low rectal cancer was 3. The AUC of the RAREAL model was 0.764, its diagnostic sensitivity and specificity were 41.9% and 99.5%, respectively, and the AUC of the validation group was 0.757, its diagnostic sensitivity was 47.1% and specificity was 98.9%. the AUC of the ROC of the two groups was not significantly different (P\u0026thinsp;=\u0026thinsp;0.939), indicating the good predictive function of the RAREAL model. During DIXON operation for rectal cancer, the RAREAL score can be performed. If the score is more than 4.5, the possibility of postoperative AL is high.\u003c/p\u003e \u003cp\u003eIf AL occurs after rectal cancer surgery in a patient, DS can protect the patient from complications such as sepsis. But the cost of DS is many DS related complications, the huge risk of possible DS related emergency surgery, and the decline in the quality of life after the DS. the DS should be determined according to the specific situation of each patient. Especially when new situations arise during surgery that do not match preoperative predictions, the DS or not, is sometimes a difficult option for the surgeon. The RAREAL model is a relatively simple and easy to master, established a score of 4.5 as a reference for clinicians and surgeons. If the score is more than 4.5, preventive DS should be performed to avoid severe postoperative infection. The variables used in RAREAL, which are simple and easy to use, are also familiar to clinicians, and this model facilitates surgeons to make rapid and correct judgments. This model may obviate the need for the DS in patients with a low risk of AL, helping to achieve a more rational allocation of healthcare resources, thus improving patient quality of life and reducing financial burden on patients.\u003c/p\u003e \u003cp\u003eOur study had the following limitations, first, the retrospective nature of our study not only made bias from patient selection and data collection difficult to avoid, but its nonrandomized study design made it impossible to control or correct for each bias in this study design. Second, the limited number of patients in the AL group in our report might hinder the discovery of more other risk factors for AL in our study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the RAREAL score can be used to assess the risk of AL after Dixon surgery for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 4.5.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRAREAL \u0026nbsp; \u0026nbsp;Risk assessment of rectal anastomotic leak\u003c/p\u003e\n\u003cp\u003eAL \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Anastomotic leakage\u003c/p\u003e\n\u003cp\u003eNAL \u0026nbsp; \u0026nbsp; \u0026nbsp; Non anastomotic leakage\u003c/p\u003e\n\u003cp\u003eHbA1c \u0026nbsp; \u0026nbsp; Glycated hemoglobin\u003c/p\u003e\n\u003cp\u003eDS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Diverting stoma\u003c/p\u003e\n\u003cp\u003eLCA \u0026nbsp; \u0026nbsp; \u0026nbsp; Left colic artery,\u003c/p\u003e\n\u003cp\u003eTD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tumor distance from the anal margin\u003c/p\u003e\n\u003cp\u003ePCT \u0026nbsp; \u0026nbsp; \u0026nbsp; Preoperative chemoradiotherapy\u003c/p\u003e\n\u003cp\u003eASA \u0026nbsp; \u0026nbsp; \u0026nbsp; American Society of Anesthesiologists physical status classification\u003c/p\u003e\n\u003cp\u003eIQR \u0026nbsp; \u0026nbsp; \u0026nbsp; Interquartile range\u003c/p\u003e\n\u003cp\u003eBMI \u0026nbsp; \u0026nbsp; \u0026nbsp; Body mass index\u003c/p\u003e\n\u003cp\u003eAUC \u0026nbsp; \u0026nbsp; \u0026nbsp; Area under the curve\u003c/p\u003e\n\u003cp\u003eROC \u0026nbsp; \u0026nbsp; \u0026nbsp; Receiver operating characteristic\u003c/p\u003e\n\u003cp\u003eSE \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standard error\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXC Z and JB S designed the study; XC Z conducted main literature search and wrote the first draft of the paper. JB S contributed to analytical design, data analysis and revision of the manuscript. XC Z and JB S contributed equally to this work and should be considered co-first authors. JJ Z contributed to main literature search, data analysis. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo financial support was provided for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed to X.C.Z on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present study was conducted in accordance with the World Medical Association Declaration of Helsinki. Written informed consent was obtained from all participants included in the study. The Ethics Committee of the Second Affiliated Hospital of Fujian Medical University gave the ethics approval for this retrospective study (2022208).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003ePatients signed informed consent regarding publishing their data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003eAll authors declare that they have no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOlsen BC, Sakkestad ST, Pfeffer F, Karliczek A: \u003cstrong\u003eRate of Anastomotic Leakage After Rectal Anastomosis Depends on the Definition: Pelvic Abscesses are Significant\u003c/strong\u003e. \u003cem\u003eScand J Surg \u003c/em\u003e2019, \u003cstrong\u003e108\u003c/strong\u003e(3):241-249.\u003c/li\u003e\n\u003cli\u003eWang ZJ, Liu Q: \u003cstrong\u003eA Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after 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Tiret E, Moriya Y\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eDefinition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer\u003c/strong\u003e. \u003cem\u003eSurgery \u003c/em\u003e2010, \u003cstrong\u003e147\u003c/strong\u003e(3):339-351.\u003c/li\u003e\n\u003cli\u003eKim CW, Baek SJ, Hur H, Min BS, Baik SH, Kim NK: \u003cstrong\u003eAnastomotic Leakage After Low Anterior Resection for Rectal Cancer Is Different Between Minimally Invasive Surgery and Open Surgery\u003c/strong\u003e. \u003cem\u003eAnn Surg \u003c/em\u003e2016, \u003cstrong\u003e263\u003c/strong\u003e(1):130-137.\u003c/li\u003e\n\u003cli\u003eKim JS, Cho SY, Min BS, Kim NK: \u003cstrong\u003eRisk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique\u003c/strong\u003e. \u003cem\u003eJ Am Coll Surg \u003c/em\u003e2009, 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score for prediction of anastomotic leak after rectal cancer surgery\u003c/strong\u003e. \u003cem\u003eTech Coloproctol \u003c/em\u003e2019, \u003cstrong\u003e23\u003c/strong\u003e(7):649-663.\u003c/li\u003e\n\u003cli\u003eZheng H, Wu Z, Wu Y, Mo S, Dai W, Liu F, Xu Y, Cai S: \u003cstrong\u003eLaparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer\u003c/strong\u003e. \u003cem\u003eInt J Colorectal Dis \u003c/em\u003e2019, \u003cstrong\u003e34\u003c/strong\u003e(2):319-328.\u003c/li\u003e\n\u003cli\u003eHoshino N, Hida K, Sakai Y, Osada S, Idani H, Sato T, Takii Y, Bando H, Shiomi A, Saito N: \u003cstrong\u003eNomogram for predicting anastomotic leakage after low anterior resection for rectal cancer\u003c/strong\u003e. \u003cem\u003eInt J Colorectal Dis \u003c/em\u003e2018, \u003cstrong\u003e33\u003c/strong\u003e(4):411-418.\u003c/li\u003e\n\u003cli\u003eZarnescu EC, Zarnescu NO, 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We aimed to establish a model for the risk assessment of rectal anastomotic leak (RAREAL) after Dixon in non-emergency patients with rectal cancer, using routinely available variables, by which surgeons could individualize their approach to DS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e413 patients who underwent Dixon operation for rectal cancer from January 2015 to December 2018 were taken as the model group for retrospective study. Univariate and multivariate logistic regression analysis was used to determine the independent risk factors associated with anastomotic leakage(AL). The area under the curve (AUC) of the receiver operating characteristic (ROC) and the Youden index were used to evaluate the RAREAL score. We constructed the RAREAL model. 191 patients who underwent Dixon operation due to rectal cancer from January 2019 to December 2020 were collected according to the uniform criteria as a validation group to validate the RAREAL model. The RAREAL score was performed on the patients in the modeling group, the ROC curve was used for analysis, and the Z test was used to evaluate the consistency of the ROC curve between the modeling group and the validation group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn the model group, multivariate analysis identified the following variables as independent risk factors for AL: HbA1c (odds ratio (OR)\u0026thinsp;=\u0026thinsp;7.831; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004), Left colic artery (LCA) non preservation (OR\u0026thinsp;=\u0026thinsp;7.035; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), Tumor distance from the anal margin (TD) (OR\u0026thinsp;=\u0026thinsp;14.246; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000). In the model group, the AUC of the ROC for evaluating AL with RAREAL was 0.764, and when RAREAL score\u0026thinsp;=\u0026thinsp;4.5, its sensitivity, specificity and Youden index were 0.419, 0.995, 0.415, respectively. The AUC was 0.757 in the validation group and its sensitivity and specificity were 0.471 and 0.989, respectively, when RAREAL score\u0026thinsp;=\u0026thinsp;4.5.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe RAREAL score can be used to assess the risk of AL after Dixon operation for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 4.5.\u003c/p\u003e","manuscriptTitle":"Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-26 17:23:36","doi":"10.21203/rs.3.rs-2183335/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-11-28T08:34:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-25T09:37:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"6e7b00f3-459d-4543-b7ad-524f76b4324c","date":"2022-10-20T11:54:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-10-20T11:51:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-10-20T11:49:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-10-20T11:46:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-10-20T11:41:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2022-10-19T13:59:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce28ce29-c57a-4623-b5bc-c9d4f408fd6f","owner":[],"postedDate":"October 26th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-09T15:06:17+00:00","versionOfRecord":{"articleIdentity":"rs-2183335","link":"https://doi.org/10.1186/s12876-023-02982-2","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2023-10-03 15:01:58","publishedOnDateReadable":"October 3rd, 2023"},"versionCreatedAt":"2022-10-26 17:23:36","video":"","vorDoi":"10.1186/s12876-023-02982-2","vorDoiUrl":"https://doi.org/10.1186/s12876-023-02982-2","workflowStages":[]},"version":"v1","identity":"rs-2183335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2183335","identity":"rs-2183335","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}