Risk Factors for Anastomotic Leakage After Intersphincteric Resection Without a Protective Defunctioning Stoma for Lower Rectal Cancer

Abstract Objectives Anastomotic leakage (AL) after anterior resection always leads to longer hospital stays, decreased quality of life and even increased mortality. Despite extensive research, no consensus on the world well-concerned surgical-related risk factors exists. We therefore conducted a meta-analysis of the available published literature to identify the effects of surgical-related risk factors for AL after anterior resection for rectal cancer, hoping to provide more information and improved guidance for clinical workers managing patients with rectal cancer who are at a high risk for AL. Methods In this study, the relevant articles were systematically searched from EMBASE, MEDLINE, PubMed, WangFang (Database of Chinese Ministry of Science & Technology), Chinese National Knowledge Infrastructure Database and China Biological Medicine Database. The pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Meta-analysis was performed using of RevMan 5.3 software. Results A total of 26 studies met the inclusion criteria and comprised 34238 cases. Analysis of these 26 studies showed that no defunctioning stoma was highly correlated with AL (pooled OR = 1.28, 95%CI: 1.05–1.57, P = 0.01, random effect), and intraoperative blood transfusion was significantly associated with AL (pooled OR = 1.64, 95%CI: 1.34–2.02, P = 0.02, random effect). However, the AL was not associated with type of anastomosis, type of surgery, technique of anastomosis, level of inferior mesenteric artery ligation, operation time and splenic flexure mobilization. Conclusions Depend on this meta-analysis, no defunctioning stoma and intraoperative blood transfusion are the major surgical-related risk factors for AL after resection for rectal cancer. Because of the inherent limitations of the research, future prospective randomized controlled trials will need to confirm this conclusion.

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Analysis of Risk Factors for Anastomotic Leakage after Lower Rectal Cancer Resection, Including Drain Type: A Retrospective Single-Center Study

10.21203/rs.2.24606/v2 ◽

2020 ◽

Author(s):

Tetsushi Kinugasa ◽

Sachiko Nagasu ◽

Kenta Murotani ◽

Tomoaki Mizobe ◽

Takafumi Ochi ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Anastomotic Leakage ◽

Propensity Score Analysis ◽

Univariate Analysis ◽

Underlying Disease ◽

Lower Rectal Cancer ◽

Open Drainage ◽

Related Factors ◽

Closed Drainage

Abstract Background: We investigated the correlations between surgery-related factors and the incidence of leakage after low anterior resection (LAR) for lower rectal cancer.Methods: A total of 630 patients underwent colorectal surgery between 2011 and 2014 in our department. Of these, 97 patients (15%) underwent LAR and were included in this retrospective study. Temporary ileostomy was performed in each patient.Results: Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed that operative duration (p=0.0051), transanal hand-sewn anastomosis (p=0.0141), and operation procedure (p=0.0191) were significantly associated with the occurrence of leakage. Multivariate analysis showed that underlying disease (p=0.0440), transanal hand-sewn anastomosis (p=0.0188) and drain type (p=0.0251) were significantly associated with the occurrence of leakage. Propensity-score analysis showed that closed drainage was associated with 6.3 times with anastomotic leakage than open drainage in patients, according to inverse probability of treatment-weighted analysis. Conclusions: Our results indicate that underlying disease, transanal hand-sewn anastomosis, and drain type may be risk factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that the type of drainage was related to the occurrence of anastomotic leakage: closed drainage was correlated with the less volume of postoperative drain discharge than open drain.

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Time interval between rectal cancer resection and reintervention for anastomotic leakage and the impact of a defunctioning stoma: A Dutch population‐based study

Colorectal Disease ◽

10.1111/codi.15878 ◽

2021 ◽

Author(s):

Anne‐Loes K. Warps ◽

Rob A. E. M. Tollenaar ◽

Pieter J. Tanis ◽

Jan Willem T. Dekker ◽

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Population Based ◽

Time Interval ◽

Dutch Population ◽

Population Based Study ◽

Defunctioning Stoma ◽

Cancer Resection ◽

Rectal Cancer Resection ◽

The Impact

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Risk factors for local recurrence and long term survival after minimally invasive intersphincteric resection for very low rectal cancer: Multivariate analysis in 161 patients

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.03.246 ◽

2021 ◽

Author(s):

G.N. Piozzi ◽

H. Park ◽

T.H. Lee ◽

J.S. Kim ◽

H.B. Choi ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Multivariate Analysis ◽

Local Recurrence ◽

Minimally Invasive ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Term Survival ◽

Very Low Rectal Cancer

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Risk Factors for Symptomatic Anastomotic Leakage After Low Anterior Resection for Rectal Cancer with 30 Gy/10 f/2 w Preoperative Radiotherapy

World Journal of Surgery ◽

10.1007/s00268-010-0449-9 ◽

2010 ◽

Vol 34 (5) ◽

pp. 1080-1085 ◽

Cited By ~ 36

Author(s):

Lin Wang ◽

Jin Gu

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Preoperative Radiotherapy

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Retrospective Analysis of Risk Factors for Postoperative Perineal Hernia After Endoscopic Abdominoperineal Excision for Rectal Cancer

10.21203/rs.3.rs-962418/v1 ◽

2021 ◽

Author(s):

Tatsuya Manabe ◽

Yusuke Mizuuchi ◽

Yasuhiro Tsuru ◽

Hiroshi Kitagawa ◽

Takaaki Fujimoto ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Regression Analysis ◽

Odds Ratio ◽

Open Surgery ◽

Abdominoperineal Excision ◽

Perineal Hernia ◽

Lower Rectal Cancer ◽

Peritoneal Closure ◽

Initial Surgery

Abstract Background: In contrast to open-surgery abdominoperineal excision (APE) for rectal cancer, postoperative perineal hernia (PPH) is reported to increase after extralevator APE and endoscopic surgery. In this study, therefore, we aimed to determine the risk factors for PPH after endoscopic APE.Methods: A total 73 patients who underwent endoscopic APE for lower rectal cancer were collected from January 2009 to March 2020, and the risk factors for PPH were analyzed retrospectively.Results: Nineteen patients (26%) developed PPH after endoscopic APE, and the diagnosis of PPH was made at 9–393 days (median: 183 days) after initial surgery. Logistic regression analysis showed that absence of pelvic peritoneal closure alone increased the incidence of PPH significantly (odds ratio; 13.76, 95% confidence interval; 1.48–1884.84, p = 0.004).Conclusions: Pelvic peritoneal closure should be performed when possible after endoscopic APE to prevent PPH.

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