Prediction of anastomotic leakage after anterior rectal resection

Objective: Anastomotic Leakage (AL) is one of the most common complications after resection of rectal cancer. Recognition of the incidence and risk factors related to AL is important. This study aimed develops a model that can predict anastomotic leakage after anterior rectal resection. Methods: Data from 188 patients undergoing anterior resection of rectal cancer were collected for retrospective analysis. Patients were randomly divided in the development set and validation set at a 1:1 ratio. We first included age, sex, preoperative chemoradiotherapy, tumor size, degree of tumor differentiation, stage, TNM stage, lymph vascular invasion, distance, anastomotic method, diabetes, intraoperative time, intraoperative bleeding and smoking as candidates for variable selection with a LASSO method. A ROC curve was constructed with the validation set to assess the accuracy of the prediction model. Results: AL occurred in 20 of 188 patients (10.6%). Preoperative chemoradiotherapy (p=0.04), medium degree of tumor differentiation (p=0.04), anastomotic method (p<0.01), intraoperative bleeding≥400ml (p<0.01), smoking (p<0.01), diabetes (p<0.01) were significantly related to AL. The area under the ROC curve of the prediction model is 0.952. Conclusions: This study developed a model that can predict anastomotic leakage after anterior rectal resection, which may aid the selection of preventive ileostomy and postoperative management. doi: https://doi.org/10.12669/pjms.35.3.252 How to cite this:Cheng S, He B, Zeng X. Prediction of anastomotic leakage after anterior rectal resection. Pak J Med Sci. 2019;35(3):830-835. doi: https://doi.org/10.12669/pjms.35.3.252 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Risk of Outlet Obstruction Associated With Defunctioning Loop Ileostomy in Rectal Cancer Surgery

Cancer Diagnosis & Prognosis ◽

10.21873/cdp.10062 ◽

2021 ◽

Vol 1 (5) ◽

pp. 465-470

Author(s):

HIROYA ENOMOTO ◽

KATSUHITO SUWA ◽

NANA TAKEUCHI ◽

YOSHITO HANNYA ◽

YUHEI TSUKAZAKI ◽

...

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Odds Ratio ◽

Rectal Resection ◽

Univariate Analysis ◽

Outlet Obstruction ◽

Muscle Thickness ◽

Rectus Abdominis ◽

Rectus Abdominis Muscle ◽

Anterior Rectal Resection

Background: The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic leakage; OO affects a patient’s quality of life and prolongs hospitalization. Patients and Methods: A retrospective analysis was performed of patients who underwent anterior rectal resection and DI for rectal cancer. Results: Among 100 patients undergoing anterior rectal resection with DI for rectal cancer, 28 (28%) developed OO. Anastomotic leakage and a rectus abdominis muscle thickness ≥10 mm on preoperative computed tomography were significantly associated with the risk of OO in univariate analysis. Multivariate analysis also demonstrated that anastomotic leakage (odds ratio=4.320, 95% confidence interval=1.280-14.60, p=0.019) and rectus abdominis muscle thickness ≥10 mm (odds ratio=3.710, 95% confidence intervaI=1.280-10.70, p=0.016) were significantly risk factors for OO. Conclusion: When OO is observed, an anastomotic leakage should be suspected, especially if there is a high rectus abdominis muscle thickness.

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Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer

Polish Journal of Surgery ◽

10.1515/pjs-2015-0031 ◽

2015 ◽

Vol 87 (3) ◽

Author(s):

Jerzy Piecuch ◽

Maciej Wiewióra ◽

Monika Szrot ◽

Janusz Jopek ◽

Albert Krzak ◽

...

Keyword(s):

Body Mass Index ◽

Rectal Cancer ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Rectal Resection ◽

Group Iii ◽

Group I ◽

Anterior Rectal Resection ◽

Mechanical Suture ◽

The Relationship

AbstractAnterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory.The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. Material and methods. This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI < 23.8 kg/mResults. Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53).Conclusions. The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer.

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P.08.14 LONG TERM EFFICACY OF VACUUM-ASSISTED THERAPY (ENDO-SPONGE) IN ANASTOMOTIC LEAKAGE FOLLOWING ANTERIOR RECTAL RESECTION

Digestive and Liver Disease ◽

10.1016/s1590-8658(12)60385-5 ◽

2012 ◽

Vol 44 ◽

pp. S139

Author(s):

A. Buzzi ◽

A. Mussetto ◽

I. Tampieri ◽

M.L. Brancaccio ◽

T. Casetti

Keyword(s):

Anastomotic Leakage ◽

Rectal Resection ◽

Term Efficacy ◽

Anterior Rectal Resection

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Sphincter-saving extrasphincteric rectal dissection and proximal segmental sphincteric excision techniques by using combined abdominal and transvaginal anterior perineal access in female patients who have lower rectal cancer ( Transvaginal low anterior rectal resection )

Journal of Coloproctology ◽

10.1016/j.jcol.2017.05.005 ◽

2017 ◽

Vol 37 (4) ◽

pp. 332-335

Author(s):

Ali Naki Yücesoy

Keyword(s):

Rectal Cancer ◽

Rectal Resection ◽

Lower Rectal Cancer ◽

Female Patients ◽

Anterior Rectal Resection ◽

Sphincter Saving

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The Functional Outcomes of Coloanal and Low Colorectal Anastomoses with Reservoirs after Low Rectal Cancer Resections

The American Surgeon ◽

10.1177/000313481408001224 ◽

2014 ◽

Vol 80 (12) ◽

pp. 1222-1229 ◽

Cited By ~ 7

Author(s):

FranÇ Ois Rubin ◽

Richard Douard ◽

Philippe Wind

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Functional Outcomes ◽

Functional Results ◽

Functional Impairments ◽

Level Of Evidence ◽

Anastomotic Complications ◽

Colorectal Anastomoses ◽

Anterior Rectal Resection ◽

Colonic Reservoir

Nearly half of patients undergoing low anterior rectal cancer resection have a functional sequelae after straight coloanal or low colorectal anastomoses (SA), including low anterior rectal resection syndrome, which combines stool fragmentation, urge incontinence, and incontinence. SA are responsible for anastomotic leakage rates of 0 to 29.2 per cent. Adding a colonic reservoir improves the functional results while reducing anastomotic complications. These colonic reservoir techniques include the colonic J pouch (CJP), transverse coloplasty (TC), and side-to-end anastomosis (STEA) procedures. The aim of this literature review was to compare the functional outcomes of these three techniques from a high level of evidence. CJP with a 4- to 6-cm reservoir is a good surgical option because it reduces functional impairments during the first year, and probably up to 5 years, but is not always feasible. TC appears to perform as well as CJP, is achievable in over 95 per cent of patients, but still with some doubts about a higher anastomotic leakage rate and worse functional outcomes. STEA appears equivalent to CJP in terms of morbidity and even better functional outcomes. STEA, with a terminal side segment size of 3 cm, is feasible in the majority of nonobese patients, combines good functional results, has low anastomotic leakage rates, and is easy to complete.

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Prediction model for ypΝ status after preoperative chemoradiotherapy in patients with rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.513 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 513-513 ◽

Cited By ~ 1

Author(s):

Eunjin Jwa ◽

Jong Hoon Kim ◽

Seungbong Han ◽

Jin-hong Park ◽

Jin Cheon Kim ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Prediction Model ◽

Cancer Patients ◽

Local Excision ◽

Preoperative Chemoradiotherapy ◽

Lymph Node Status ◽

Node Metastasis ◽

Nodal Stage

513 Background: Pelvic lymph node status after preoperative chemoradiotherapy (CRT) is not only an important indicator for oncologic outcome but critical information to determine the type of a subsequent surgical resection (i.e. curative surgery or local excision) in patients with locally advanced rectal cancer. The purpose of this study is to develop a nomogram to predict the lymph node status after preoperative CRT in rectal cancer patients whose ypT information is available. Methods: Using logistic regression analyses, we constructed a prediction model to predict the probability of lymph node metastasis after preoperative CRT in a cohort of 1,099 patients with rectal cancer treated with preoperative CRT and total mesorectal excision (TME) from 2007 to 2011. The model was internally validated for discrimination and calibration using bootstrap resampling. Results: Pretreatment clinical nodal stage, distant metastasis, pre- and post-treatment tumor differentiation, and ypT stage were reliable predictors for lymph node metastasis after preoperative CRT. The nomogram developed using these parameters represents a valid and accurate method for predicting lymph node metastasis after preoperative CRT in rectal cancer patients. (c-index: 0.75) Patients with low pretreatment nodal stage, nonmetastatic, and well differentiated rectal adenocarcinoma downstaged to ypT0-1 after preoperative CRT will have low chance of pelvic lymph node involvement. Conclusions: Our model is expected to assist clinicians in quantifying the benefit of radical resection and finding out the patient group who can be treated with local excision after preoperative CRT for rectal cancer.

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