scholarly journals A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Zhi-Jie Wang ◽  
Qian Liu
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Univariate Analysis ◽  
Control Group ◽  
Primary Malignancy ◽  
Laparoscopic Anterior Resection ◽  
Diverting Stoma ◽  
Independent Risk Factors ◽  
Intraoperative Chemotherapy

Background. Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality. Moreover, it might be associated with a worse oncological prognosis of tumors. This study is aimed at exploring the risk factors for symptomatic AL after laparoscopic anterior resection (LAR) for rectal tumors without a preventive diverting stoma. Materials and Methods. This case control study retrospectively reviewed the data of 496 consecutive patients who underwent LAR of the rectum without a preventive diverting stoma at the Cancer Hospital, Chinese Academy of Medical Sciences between September 2016 and September 2017. All patients were divided into an AL group and a control group based on the occurrence of postoperative symptomatic AL. Factors regarding patient-related variables, operation-related variables, and tumor-related variables were collected and assessed between the two groups through univariate and multivariate logistic regression analyses to identify independent risk factors for AL. Results. In total, 18 (3.6%) patients developed postoperative symptomatic AL. Univariate analysis showed that a synchronous primary malignancy of the left hemicolon (P=0.047), intraoperative chemotherapy (P=0.003), and level of anastomosis (P=0.033) were significantly related with AL. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P=0.011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P=0.013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P=0.030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Conclusions. Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma.

scholarly journals Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage After Low Anterior Resection in Rectal Cancer Patients

2020 ◽  
Vol 36 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Byoung Chul Lee ◽  
Seok-Byung Lim ◽  
Jong Lyul Lee ◽  
Chan Wook Kim ◽  
Yong Sik Yoon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Clinicopathological Parameters ◽  
Emergency Laparotomy ◽  
Stoma Formation ◽  
Diverting Stoma ◽  
The Impact ◽  
Protective Stoma

Purpose: This study aimed to identify risk factors for anastomotic leakage and to evaluate the impact of protective stoma on the rate of anastomotic leakage and subsequent management.Methods: This retrospective study analyzed data from 4,282 patients who underwent low anterior resection between 2007 and 2014. Among these, 1,367 (31.9%) underwent surgery to create protective diverting stoma and 232 (5.4%) experienced anastomotic leakage. At 6-month timepoints, data were evaluated to identify any correlation between the presence of diverting stoma and the incidence of anastomotic leakage. In addition, clinicopathological parameters were investigated to identify risk factors for anastomotic leakage.Results: Diverting stomas significantly reduced the rate of anastomotic leakage (hazard ratio, 0.334; 95% confidence interval, 0.212–0.525; P<0.001], which was reciprocally correlated with the rate of diverting stoma formation (P=0.039). Patients with a diverting stoma had a significantly lower incidence of generalized peritonitis (P<0.001) and therefore significantly reduced need for laparotomy (82.7% vs. 39.1%, P<0.001).Conclusion: The selective use of diverting stoma in high-risk patients decreases the rate of anastomotic leakage. Diverting stoma also affects the type of leakage and reduces the need for emergency laparotomy by approximately 40%.

scholarly journals Pathophysiology and Risk Factors for Cholelithiasis in Patients with Crohn’s Disease

2019 ◽  
pp. S173-S182
Author(s):  
I. STURDIK ◽  
A. KRAJCOVICOVA ◽  
Y. JALALI ◽  
M. ADAMCOVA ◽  
M. TKACIK ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Parenteral Nutrition ◽  
Univariate Analysis ◽  
Abdominal Ultrasound ◽  
Control Group ◽  
Healthy Population ◽  
Retrospective Case ◽  
Independent Risk Factors

Cholelithiasis is more common in patients with Crohn’s disease (CD) than in the healthy population. The aim here was to examine risk factors for cholelithiasis in a cohort of CD patients and to compare the prevalence of cholelithiasis in a cohort of CD patients with that in a control group. This was a single-center retrospective case-control study. The cohort comprised all consecutive CD patients who underwent abdominal ultrasound from January 2007 to January 2018. The control group comprised age- and gender-matched non-CD patients referred for upper gastrointestinal tract dyspepsia. The study included 238 CD patients and 238 controls. The prevalence of cholelithiasis in the CD and control groups was 12.6 % and 9.2 %, respectively (risk ratio (RR), 1.36; p=0.24). Univariate analysis revealed that cholelithiasis was associated with multiple risk factors. Multivariate analysis identified age (OR, 1.077; 95 % CI, 1.043–1.112; p<0.001) and receipt of parenteral nutrition (OR, 1.812; 95 % CI, 1.131–2.903; p=0.013) as independent risk factors for cholelithiasis in CD patients. The prevalence of cholelithiasis in CD patients was higher than that in the control group; however, the difference was not statistically significant. Age and receipt of parenteral nutrition were independent risk factors for cholelithiasis in CD patients.

Anastomotic Leakage after Anterior Resection for Rectal Cancer with Mesorectal Excision: Incidence, Risk Factors, and Management

2015 ◽  
Vol 81 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Antonio Pio Tortorelli ◽  
Sergio Alfieri ◽  
Alejandro Martin Sanchez ◽  
Fausto Rosa ◽  
Valerio Papa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Anal Verge ◽  
Univariate Analysis ◽  
Postoperative Mortality ◽  
Incidence Risk ◽  
Clinical Consequences

We investigated risk factors and prognostic implications of symptomatic anastomotic leakage after anterior resection for rectal cancer, and the influence of a diverting stoma. Our retrospective review of prospective collected data analyzed 475 patients who underwent anterior resection for rectal cancer. Uni- and multivariate analysis was made between anastomotic leakage and patient, tumor, and treatment variables, either for the overall group (n = 475) and in the midlow rectal cancer subgroup (n = 291). Overall rate of symptomatic leakage was 9 per cent (43 of 475) with no related postoperative mortality. At univariate analysis, significant factors for leak were a tumor less than 6 cm from the anal verge (13.7 vs 6.6%; P = 0.011) and intraoperative transfusions (16.9 vs 4.3%; P = 0.001). Similar results were observed in the midlow rectal cancer subgroup. At multivariate analysis, no parameter resulted in being an independent prognostic factor for risk of leakage. In patients with a leakage, a temporary enterostomy considerably reduced the need for reoperation (12.5 vs 77.8%; P < 0.0001) and the risk of a permanent stoma (18.7 vs 28.5%; P = 0.49). The incidence of anastomotic failure increases for lower tumors, whereas it is not influenced by radiotherapy. Defunctioning enterostomy does not influence the leak rate, but it mitigates clinical consequences.

scholarly journals Independent risk factors and the potential predictors of bladder cancer-related ischemic stroke

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091922
Author(s):  
Xuemei Quan ◽  
Qixiong Qin ◽  
Ya Chen ◽  
Yunfei Wei ◽  
Xianlong Xie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Ischemic Stroke ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
Predictive Performance ◽  
Roc Curves ◽  
Control Group ◽  
Independent Risk Factors ◽  
D Dimer

Objective To investigate the independent risk factors and potential predictors of bladder cancer-related ischemic stroke (BCRIS). Methods This was a multi-center retrospective study including patients with active bladder cancer and acute ischemic stroke without traditional stroke risk factors (BCRIS group), and sex- and age-matched patients with active bladder cancer alone (control group). Data were collected between January 2006 and December 2018. Uni- and multivariate analyses were performed to identify independent risk factors for BCRIS. The predictive performance of these risk factors was assessed using receiver operating characteristic (ROC) curves. Results Records were retrospectively reviewed from 60 BCRIS patients and 120 bladder cancer controls. Univariate analysis revealed that serum D-dimer and carcinoembryonic antigen (CEA) levels and the platelet and neutrophil counts were significantly higher in BCRIS patients compared with controls. Multivariate analysis identified the three above-mentioned variables as independent risk factors for BCRIS. The product of all three factors gave the largest area under the ROC curve. Conclusions Elevated serum D-dimer and CEA levels and increased platelet count were independent risk factors for BCRIS, and the cut-off value based on the product of the three independent risk factors (≥2,640,745.29) could serve as a potential predictor of BCRIS.

scholarly journals The Analysis of Etiology and Risk Factors for 192 Cases of Neonatal Sepsis

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ting Xiao ◽  
Li-Ping Chen ◽  
Hui Liu ◽  
SiSi Xie ◽  
Yan Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Neonatal Sepsis ◽  
Univariate Analysis ◽  
Control Group ◽  
Bacterial Strains ◽  
Roc Curve Analysis ◽  
Soluble Cd14 ◽  
Independent Risk Factors ◽  
Pediatric Sepsis

This study aimed to investigate the etiology and risk factors of neonatal sepsis. A retrospective analysis was conducted on 192 patients with sepsis from August 2013 to March 2015. One hundred and six healthy neonates were used as the control group. Logistic regression was used to analyze the risk factors and ROC curve analysis performed in laboratory which indicated a significant correlation. The results of univariate analysis showed that postnatal age, body weight, and parity were significantly related to neonatal sepsis (P<0.5). Logistic regression analysis demonstrated that postnatal age and parity are independent risk factors for neonatal sepsis (OR were 1.176 and 0.692, resp., P<0.001). The maximum area underneath the curve (ROCAUC) of soluble CD14 (sCD14-ST), which was the most indicative biomarker of sepsis diagnostically, was 0.953 with sensitivity and specificity of 93.8% and 84.9%, respectively. Escherichia coli, Staphylococcus aureus, and Streptococcus agalactiae were the main bacterial strains causing neonatal sepsis, while postnatal age was an independent risk factor for the onset of disease. sCD14-ST could be a potential useful diagnostic marker for pediatric sepsis.

PS01.132: RISK FACTORS OF ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY WITH GASTRIC TUBE RECONSTRUCTION FOR THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 87-87
Author(s):  
Atsushi Sugimoto ◽  
Takahiro Toyokawa ◽  
Tatsuro Tamura ◽  
Katsunobu Sakurai ◽  
Naoshi Kubo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Circular Stapler ◽  
Thoracic Esophageal Cancer ◽  
Independent Risk Factors ◽  
Mechanical Anastomosis

Abstract Background Anastomotic leakage is a major complication after esophagectomy. Recent studies reported that anastomotic leakage is associated with poor prognosis. We aimed to identify the risk factors of anastomotic leakage after esophagectomy for thoracic esophageal cancer. Methods We analyzed retrospectively consecutive patients who underwent esophagectomy with reconstruction using gastric tube by cervical anastomosis for thoracic esophageal cancer between January 2009 and December 2017. In the reconstruction, end-to side mechanical anastomosis with circular stapler through the posterior mediastinal route was preferred until 2014, and end-to end hand-sewn anastomosis through the retrosternal route was preferred from 2015. As inflammation-based and/or nutritional markers, prognostic nutritional index (PNI), modified Glasgow Prognostic Score (mGPS), Controlling Nutritional Status (CONUT) score, and neutrophil lymphocyte ratio (NLR) were investigated. Receiver operator characteristic curve analyses were performed to set the cut-off value of continuous variables. Risk factors predicting anastomotic leakage were analyzed using logistic regression model. Results A total of 170 patients (144 males and 26 females) were evaluated. Median age was 65 years (59 − 70). Anastomotic leakage was observed in 21 patients (12.3%). A mechanical anastomosis with circular stapler (P = 0.047) and longer operative time (≧560 minutes) (P = 0.015) were identified as risk factors of anastomotic leakage in univariate analysis. Multivariate analysis including variables with P < 0.1 on univariate analyses identified lower PNI (< 45) (P = 0.044, OR 2.78, 95% CI: 1.02 − 7.56) and mechanical anastomosis with a circular stapler (P = 0.036, OR 3.30, 95% CI: 1.07 − 10.09) as independent risk factors. Conclusion Our findings suggested that preoperative lower PNI and mechanical anastomosis were independent risk factors of anastomotic leakage after esophagectomy. Further studies aimed at preoperative nutritional intervention and anastomotic technique are warranted. Disclosure All authors have declared no conflicts of interest.

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