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 Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Masahiro Fukada ◽  
Nobuhisa Matsuhashi ◽  
Takao Takahashi ◽  
Hisashi Imai ◽  
Yoshihiro Tanaka ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Blood Loss ◽  
Anastomotic Leakage ◽  
Predictive Factors ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Univariate Analysis ◽  
Intraoperative Blood Loss ◽  
Laparoscopic Low Anterior Resection

Abstract Background In recent years, laparoscopic surgery has been widely used for rectal cancer. In laparoscopic rectal surgery, a double-stapling technique (DST) anastomosis using a stapling device is considered a relatively difficult procedure. Postoperative anastomotic leakage (AL) is a major complication related to patients’ quality of life and prognosis. Methods This study was a retrospective, single-institution study of 101 rectal cancer patients who underwent laparoscopic low anterior resection (LAR) with DST anastomosis (excluding simultaneous resection of other organs and construction of protective diverting stoma) between February 2008 and November 2017 at the Gifu University Graduate School of Medicine. This study aimed to identify risk and early predictive factors of AL. Results Among 101 patients, symptomatic AL occurred in 13 patients (12.9%), of whom 10 were male and 3 were female. Their median BMI was 22.7 kg/m2 (range, 17.9–26.4 kg/m2). Among the pre- and intraoperative factors, AL was significantly associated with tumor location (lower rectum), distance from the anal verge (< 6 cm), intraoperative blood loss (≥ 50 ml), and the number of linear staples (≥ 2) in univariate analysis. In multivariate analysis, only intraoperative blood loss (≥ 50 ml, odds ratio [OR] 4.59; 95% confidence interval [CI] 1.04–19.52; p = 0.045) was identified as an independent risk factor for AL. Among the postoperative factors, AL was significantly associated with tachycardia-POD1 (≥ 100 bpm), CRP-POD3 (≥ 15 mg/dl), fever on postoperative day (fever-POD) 3 (≥ 38 °C), and first defecation day after surgery (< POD3) in univariate analysis. In multivariate analysis, fever-POD3 (≥ 38 °C, OR 30.97; 95% CI 4.68–311.22; p = 0.0003) and first defecation day after surgery (< POD3, OR 5.82; 95% CI 1.34–31.30; p = 0.019) were identified as early predictive factors for AL. Conclusion In this study, intraoperative blood loss was an indicator of difficulty in a transection and anastomosing procedure, and fever-POD3 and early first defecation day after surgery were independent early predictive factors for AL. Careful surgery using an appropriate technique and standardized procedures with minimal bleeding and careful postoperative management paying attention to fever and defecation may prevent the onset and severity of AL.

Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer

2007 ◽  
Vol 22 (8) ◽  
pp. 919-927 ◽  
Author(s):  
Martin Kruschewski ◽  
Hayo Rieger ◽  
Uwe Pohlen ◽  
Hubert G. Hotz ◽  
Heinz J. Buhr
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Elective Surgery ◽  
Postoperative Mortality

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.

Anastomotic leakage after anterior resection for rectal cancer: risk factors

2010 ◽  
Vol 12 (1) ◽  
pp. 37-43 ◽  
Author(s):  
C. A. Bertelsen ◽  
A. H. Andreasen ◽  
T. Jørgensen ◽  
H. Harling ◽  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Cancer Risk ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Cancer Risk Factors

scholarly journals Risk Factors for Anastomotic Leakage after a Low Anterior Resection for Rectal Cancer

2007 ◽  
Vol 23 (5) ◽  
pp. 365 ◽  
Author(s):  
Seok-jun Yoon ◽  
Jin-soo Kim ◽  
Byung-so Min ◽  
Nam-Kyu Kim ◽  
Seung-Hyuk Baik ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection
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