scholarly journals Impact of intratumor heterogeneity on diffusion-weighted MRI as a prognostic indicator in lower rectal cancer

2020 ◽  
Author(s):  
Michihiro Kudou ◽  
Masayoshi Nakanishi ◽  
Yoshiaki Kuriu ◽  
Tomohiro Arita ◽  
Hiroki Shimizu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Tumor Heterogeneity ◽  
Univariate Analysis ◽  
Prognostic Indicator ◽  
Imaging Biomarker ◽  
Intratumor Heterogeneity ◽  
Lower Rectal Cancer ◽  
High Group ◽  
Free Survival ◽  
Poorly Differentiated

Abstract Background Diffusion-weighed MRI (DWI) has the potential to reveal intra-tumor pathological heterogeneity consisting of the stroma. The present study investigated the value of intra-tumor heterogeneity evaluated by DWI for predicting the survival of patients with lower rectal cancer (LRC). Methods A total of 172 LRC patients underwent radical surgery between 2009 and 2017. Patients with T1 tumors, distant metastasis, and no pre-operative MRI were excluded. Fifty-eight cases were targeted. Intra-tumor heterogeneity on DWI was quantified by an image analysis (MRI heterogeneous score of DWI: mrHSD). All enrolled cases were divided into two groups (high and low groups) according to median mrHSD. Results Median mrHSD was 0.457 (0.170–0.823), with a higher score indicating a more heterogeneous pattern on DWI. The frequency of a clinical diagnosis of lymph node metastasis and extramural vascular invasion was higher in the high group. Three-year overall survival (OS) and relapse-free survival (RFS) rates were significantly higher in the low group than in the high group (OS: 100% vs 84.6%, p = 0.012; RFS: 85.9% vs 55.6%, p = 0.027). A univariate analysis of RFS showed that the RFS rates of poorly differentiated LRC, a positive circumferential resection margin on MRI, and high mrHSD were worse (p = 0.097, 0.086, and 0.049). A multivariate analysis revealed that high mrHSD tended to be an independent factor for predicting post-operative recurrence (HR: 2.836, p = 0.060). Conclusion The quantitative evaluation of intratumor heterogeneity on DWI has potential as an imaging biomarker for predicting post-operative recurrence.

scholarly journals The Elevated Pre-Treatment C-Reactive Protein Predicts Poor Prognosis in Patients with Locally Advanced Rectal Cancer Treated with Neo-Adjuvant Radiochemotherapy

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 780
Author(s):  
Richard Partl ◽  
Katarzyna Lukasiak ◽  
Eva-Maria Thurner ◽  
Wilfried Renner ◽  
Heidi Stranzl-Lawatsch ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
C Reactive Protein ◽  
Adjuvant Radiochemotherapy ◽  
Free Survival ◽  
Reactive Protein ◽  
Pre Treatment

The aim of the present study was to investigate the association of the pre-treatment C-reactive protein (CRP) plasma level with survival outcomes in a cohort of 423 consecutive patients with locally advanced rectal cancer treated with neo-adjuvant radiochemotherapy followed by surgical resection. To evaluate the prognostic value of the CRP level for clinical endpoints recurrence-free survival (RFS), local-regional control (LC), metastases-free survival (MFS), and overall survival (OS), uni- and multivariate Cox regression analyses were applied, and survival rates were calculated using Kaplan–Meier analysis. The median follow-up time was 73 months. In univariate analyses, the pre-treatment CRP level was a significant predictor of RFS (hazard ratio (HR) 1.015, 95% CI 1.006–1.023; p < 0.001), LC (HR 1.015, 95% CI 1.004–1.027; p = 0.009), MFS (HR 1.014, 95% CI 1.004–1.023; p = 0.004), and OS (HR 1.016, 95% CI 1.007–1.024; p < 0.001). Additionally, univariate analysis identified the MRI circumferential resection margin (mrCRM) and pre-treatment carcinoembryonic antigen (CEA) as significant predictor of RFS (HR 2.082, 95% CI 1.106–3.919; p = 0.023 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). Univariate analysis also revealed a significant association of the mrCRM (HR 2.089, 95% CI 1.052–4.147; p = 0.035) and CEA (HR 1.006, 95% CI 1.003–1.008; p < 0.001) with MFS. Age and CEA were prognostic factors for OS (HR 1.039, 95% CI 1.013–1.066; p = 0.003 and HR 1.005, 95% CI 1.002–1.008; p < 0.001). In multivariate analysis that included parameters with a p-level < 0.20 in univariate analysis, the pre-treatment CRP remained a significant prognostic factor for RFS (HR 1.013, 95%CI 1.001–1.025; p = 0.036), LC (HR 1.014, 95% CI 1.001–1.027; p = 0.031), and MFS (HR 1.013, 95% CI 1.000–1.027; p = 0.046). The results support the hypothesis that an elevated pre-treatment CRP level is a predictor of poor outcome. If confirmed by additional studies, this easily measurable biomarker could contribute to the identification of patients who might be candidates for more aggressive local or systemic treatment approaches or the administration of anti-inflammatory drugs.

scholarly journals Neutrophil-to-Lymphocyte Ratio is a Prognostic Predictive Factor for Local Advanced Lower Rectal Cancer Treated with Curative Surgical Treatment after Neoadjuvant Chemoradiotherapy: A Single-Center Retrospective Cohort Study

2021 ◽  
Author(s):  
Ryosuke Nakagawa ◽  
Shimpei Ogawa ◽  
Yuji Inoue ◽  
Takeshi Ohki ◽  
Yoshiko Bamba ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Operation Time ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lower Rectal Cancer ◽  
Curative Surgery ◽  
Lymphocyte Ratio ◽  
Significant Difference

Abstract Background: The neutrophil-to-lymphocyte ratio (NLR) correlates with relapse-free survival (RFS) and may be a predictor of recurrence in patients after curative surgery for colorectal cancer. This study aimed to analyze the long-term oncological outcomes of locally advanced lower rectal cancer treated with curative surgery after neoadjuvant chemoradiotherapy (nCRT) to examine the prognostic value of the NLR and to evaluate the fluctuation of pre- and post-CRT NLR as recurrence risk factors.Methods: Fifty-two patients who underwent curative surgery were enrolled between 2009 and 2016. A cut-off pre-CRT NLR of 3.20 was used based on receiver-operating characteristic curve analysis. The primary outcome was RFS. Factors influencing recurrence after treatment according to fluctuations between the pre- and post-CRT NLR were also analyzed.Results: Univariate analysis was performed using 17 clinicopathological factors thought to affect RFS. A significant difference was found in the pre-CRT NLR (hazard ratio [HR]: 7.626, 95% confidence interval [CI]: 2.760-21.06, p<0.0001), operation time (HR: 2.949, 95% CI: 1.137-7.646, p=0.0261), and pathological T stage (HR: 8.342, 95% CI: 2.458-28.306 p=0.0007). RFS according to the pre-CRT NLR using Kaplan–Meier analysis showed that the group with pre-CRT ≥3.20 had a lower 5-year RFS (p=0.001). A lower pre-CRT NLR resulted in a significantly higher recurrence rate, regardless of the increase or decrease in the pre- and post-CRT NLR.Conclusions: The pre-CRT NLR may be a predictor of prognosis in patients with locally advanced lower rectal cancer after nCRT.

scholarly journals Prognostic Nutritional Index and its Dynamics After Curative Treatment are Independent Prognostic Factors on Survival in Non-Metastatic Nasopharyngeal Carcinoma

2021 ◽  
Author(s):  
Ahmet Küçükarda ◽  
Bülent Erdoğan ◽  
Ali Gökyer ◽  
Sezin Sayın ◽  
İvo Gökmen ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Nasopharyngeal Cancer ◽  
Prognostic Nutritional Index ◽  
Prognostic Indicator ◽  
Post Treatment ◽  
Curative Treatment ◽  
Predictive Values ◽  
Free Survival ◽  
Nutritional Index ◽  
Pre Treatment

Abstract Purpose: We aimed to identify the prognostic and predictive values of post-treatment prognostic nutritional index (PNI) and PNI dynamics in nasopharyngeal cancer patients (NPC) in this study.Methods: 107 non-metastatic NPC patients were included. PNI was calculated by using the following formula: [10 x serum albumin value (gr/dL)] + [0.005 x total lymphocyte count (per mm3)]. ROC analysis was used for determining prognostic PNI values and univariate and multivariate statistical analyses for prognostic characterization of PNI. Results: The statistically significant cut-off values for pre-and post-treatment PNI were 50.65 and 44.75, respectively. Of the pre-treatment PNI analysis, PNI≤50.65 group had shorter loco-regional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS). Furthermore, for post-treatment PNI analysis, PNI≤44.75 group had shorter LRRFS and OS. In univariate analysis, only pre-treatment PNI was associated with LRRFS and DMFS, while pre-and post-treatment PNI were both associated with OS. In multivariate analysis, both PNI were independent prognostic markers for OS. In the combined analysis, pre-and post-treatment PNI, differences between the groups were statistically significant, and the PNI dynamics was an independent prognostic indicator for OS. Conclusion: PNI is a useful, independent prognostic marker for non-metastatic NPC patients. It is used for either pre-or post-treatment patients. Furthermore, changes in pre-treatment PNI value after curative treatment is a significant indicator for OS.

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

2020 ◽  
Author(s):  
Tetsushi Kinugasa ◽  
Sachiko Nagasu ◽  
Kenta Murotani ◽  
Tomoaki Mizobe ◽  
Takafumi Ochi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Underlying Disease ◽  
Lower Rectal Cancer ◽  
Open Drainage ◽  
Related Factors ◽  
Closed Drainage ◽  
Score Analysis

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=0.005), transanal hand-sewn anastomosis (p=0.014), and operation procedure (p=0.019) were significantly associated with the occurrence of leakage. Multivariate analysis showed that underlying disease (p=0.044), transanal hand-sewn anastomosis (p=0.019) and drain type (p=0.025) were significantly associated with the occurrence of leakage. Propensity-score analysis showed that closed drainage were 6.3 times more likely to have anastomotic leakage than open drainage in relation to the amount of postoperative drainage (ml), according to inverse probability of treatment-weighted analysis.Conclusions: Our results indicate that underlying disease, transanal hand-sewn anastomosis, and closed drain may be risk factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that closed drainage was related to the occurrence of anastomotic leakage and closed drainage was correlated with the less volume of postoperative drain discharge than open drain.

scholarly journals Lymphocyte to C-reactive protein ratio predicts long-term outcomes for patients with lower rectal cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Masaaki Nishi ◽  
Mistuo Shimada ◽  
Takuya Tokunaga ◽  
Jun Higashijima ◽  
Kozo Yoshikawa ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Lower Rectal Cancer ◽  
Significant Prognostic Factor ◽  
C Reactive Protein ◽  
Curative Surgery ◽  
Protein Ratio ◽  
Reactive Protein

Abstract Backgrounds The lymphocyte to C-reactive protein (CRP) ratio (LCR) is an indicator of systemic inflammation and host–tumor cell interactions. The aim of this study was to investigate the prognostic significance of LCR in lower rectal cancer patients who received preoperative chemo-radiotherapy (CRT). Methods Forty-eight patients with lower rectal cancer who underwent CRT followed by curative surgery were enrolled in this study. Routine blood examinations were performed before and after CRT were used to calculate pre-CRT LCR and post-CRT LCR. The median LCR was used to stratify patients into low and high LCR groups for analysis. The correlation between pre- and post-CRT LCR and clinical outcomes was retrospectively investigated. Results The pre-CRT LCR was significantly higher than the post-CRT LCR (11,765 and 6780, respectively, P < 0.05). The 5-year overall survival rate was significantly higher for patients with high post-CRT LCR compared with low post-CRT LCR (90.6% and 65.5%, respectively, P < 0.05). In univariate analysis, post-CRT LCR, post-CRT neutrophil to lymphocyte ratio, and fStage were significant prognostic factors for overall survival. In multivariate analysis, post-CRT LCR, but not other clinicopathological factors or prognostic indexes, was a significant prognostic factor for overall survival (P < 0.05). Conclusions Post-CRT LCR could be a prognostic biomarker for patients with lower rectal cancer.

scholarly journals Upregulated MUC2 Is an Unfavorable Prognostic Indicator for Rectal Cancer Patients Undergoing Preoperative CCRT

2021 ◽  
Vol 10 (14) ◽  
pp. 3030
Author(s):  
Chia-Lin Chou ◽  
Tzu-Ju Chen ◽  
Yu-Feng Tian ◽  
Ti-Chun Chan ◽  
Cheng-Fa Yeh ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Locally Advanced ◽  
Treatment Resistance ◽  
Radical Resection ◽  
Advanced Rectal Cancer ◽  
Prognostic Indicator ◽  
Locally Advanced Rectal Cancer ◽  
Free Survival ◽  
Muc2 Expression

For locally advanced rectal cancer patients, introducing neoadjuvant concurrent chemoradiotherapy (CCRT) before radical resection allows tumor downstaging and increases the rate of anus retention. Since accurate staging before surgery and sensitivity prediction to CCRT remain challenging, a more precise genetic biomarker is urgently needed to enhance the management of such situations. The epithelial mucous barrier can protect the gut lumen, but aberrant mucin synthesis may defend against drug penetration. In this study, we focused on genes related to maintenance of gastrointestinal epithelium (GO: 0030277) and identified mucin 2 (MUC2) as the most significantly upregulated gene correlated with CCRT resistance through a public rectal cancer transcriptome dataset (GSE35452). We retrieved 172 records of rectal cancer patients undergoing CCRT accompanied by radical resection from our biobank. We also assessed the expression level of MUC2 using immunohistochemistry. The results showed that upregulated MUC2 immunoexpression was considerably correlated with the pre-CCRT and post-CCRT positive nodal status (p = 0.001 and p < 0.001), advanced pre-CCRT and post-CCRT tumor status (p = 0.022 and p < 0.001), vascular invasion (p = 0.015), and no or little response to CCRT (p = 0.006). Upregulated MUC2 immunoexpression was adversely prognostic for all three endpoints, disease-specific survival (DSS), local recurrence-free survival (LRFS), and metastasis-free survival (MeFS) (all p < 0.0001), at the univariate level. Moreover, upregulated MUC2 immunoexpression was an independent prognostic factor for worse DSS (p < 0.001), LRFS (p = 0.008), and MeFS (p = 0.003) at the multivariate level. Collectively, these results imply that upregulated MUC2 expression is characterized by a more advanced clinical course and treatment resistance in rectal cancer patients undergoing CCRT, revealing the potential prognostic utility of MUC2 expression.

scholarly journals Predicting prognosis according to preoperative chemotherapy response in patients with locally advanced lower rectal cancer

2019 ◽  
Author(s):  
Takuya Shiraishi ◽  
Takeshi Sasaki ◽  
Koji Ikeda ◽  
Yuichiro Tsukada ◽  
Yuji Nishizawa ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Volume ◽  
Locally Advanced ◽  
Venous Invasion ◽  
Lower Rectal Cancer ◽  
Poor Responders ◽  
Resonance Imaging ◽  
Free Survival

Abstract Background: Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, although some of these cases are systemic, and distant control may be inadequate. Neoadjuvant chemotherapy could compensate for such shortcomings, potentially yielding better survival outcomes. We aimed to stratify patients into prognostic groups on the basis of preoperative factors, including response to neoadjuvant chemotherapy. Methods: We retrospectively analyzed patients with locally advanced lower rectal adenocarcinoma (clinical stage II/III with high-risk features of distant metastasis) who were treated with neoadjuvant chemotherapy (without radiotherapy) followed by curative resection between 2010 and 2017. Reduction in tumor volume (before vs. after neoadjuvant chemotherapy) was measured using magnetic resonance imaging, and a reduction above 60% was defined as a good response. Recurrence and overall survival were evaluated. Results: The cohort comprised 102 patients. Good response to neoadjuvant chemotherapy was associated with better 5-year recurrence-free survival (good responders: 81.1%, poor responders: 49.0%; p =0.001) and 5-year overall survival (good responders: 94.9%, poor responders: 80.6%; p =0.06). In a multivariate analysis, extramural venous invasion on magnetic resonance imaging after neoadjuvant chemotherapy and a tumor volume reduction rate <60 were found to be significantly and independently associated with worse recurrence-free survival (hazard ratio: 2.74, 95% confidence interval: 1.36–5.50, p =0.005 and hazard ratio: 3.48, 95% confidence interval: 1.57–7.72, p =0.002, respectively). Good responders without extramural venous invasion had the best 5-year recurrence-free and overall survival (89.0% and 93.8%, respectively). Poor responders with extramural venous invasion had the worst 5-year recurrence-free and overall survival (21.4% and 50.0%, respectively). Conclusions: Reductions in tumor volume after neoadjuvant chemotherapy were associated with a better prognosis in patients with locally advanced lower rectal cancer. Extramural venous invasion was a preoperative prognostic factor.

scholarly journals Radiogenomics Analysis Reveals Tumor Heterogeneity of Triple-Negative Breast Cancer

2021 ◽  
Author(s):  
Lin Jiang ◽  
Chao You ◽  
Yi Xiao ◽  
He Wang ◽  
Bing Qing Xia ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Immune Suppression ◽  
Tumor Heterogeneity ◽  
Triple Negative ◽  
Intratumor Heterogeneity ◽  
Significant Prognostic Factor ◽  
Free Survival ◽  
Metabolomic Data ◽  
Breast Cancer Cohort

Abstract Triple-negative breast cancer (TNBC) is a subset of breast cancer with adverse prognosis and significant tumor heterogeneity. Here, we used MRI images from a breast cancer cohort consisting of 860 patients to construct a radiomic signature that could identify TNBC with an AUC of 0.92 (95% CI: 0.887 to 0.953) and validated in another cohort. Moreover, we developed radiomic signatures to distinguish TNBC subtypes with moderate efficacy. Furthermore, we identified peritumoral dependence nonuniformity of the gray level dependence matrix, which captures the intratumor heterogeneity in the tumor boundary, as the most significant prognostic factor (P = 0.04 for recurrence-free survival and P = 0.02 for overall survival). The integration of transcriptomic and metabolomic data indicated that high peritumor heterogeneity was related to immune suppression and enhanced metabolism. Our findings suggest that radiomics data can serve as a noninvasive predictor for molecular subtyping and clinical outcome in patients with TNBC.

Impact of duration of neoadjuvant radiation on rectal cancer survival.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 682-682
Author(s):  
Aalok Kumar ◽  
Renata D'Alpino Peixoto ◽  
Hagen F. Kennecke ◽  
Caroline Speers ◽  
Winson Y. Cheung
Keyword(s):  
Rectal Cancer ◽  
Univariate Analysis ◽  
Stage Ii ◽  
Recurrence Free Survival ◽  
Tumor Characteristics ◽  
Free Survival ◽  
N2 Disease ◽  
Significant Difference ◽  
To Receive ◽  
The Relationship

682 Background: The utility of neoadjuvant radiation (XRT) for the treatment of stages II-III rectal cancer has been demonstrated previously. However, the optimal amount and duration XRT in this setting remains unknown. Using a population-based cohort of stage II and II rectal cancer (RC) patients treated with curative intent including XRT, our aims were to 1) examine the patterns in XRT use and 2) explore the relationship between XRT course and survival. Methods: We analyzed patients diagnosed with clinical stage II-III RC from 2006 to 2010 and treated with long course 45-50.4 Gray (LC) or short course 25 Gray (SC) XRT at any 1 of 5 regional cancer centers in British Columbia. Logistic regression models were constructed to determine the factors associated with the course of XRT given, LC vs. SC. Kaplan-Meier methods and Cox regression that accounted for known prognostic factors were used to evaluate the relationship between XRT course and disease-free (DFS), overall survival (OS), local recurrence free survival (LRFS) and distant recurrence free survival (DRFS). Results: 427 patients were identified: median age 65 years (range 31 to 94), 67% men, 87% T3/4 tumors, and 74% with N1 or N2 disease. Among them, 240 (56%) received SC and 187 (44%) received LC. Adjusting for confounders, patients with N1 or N2 disease were more likely to receive LC (OR for LC 5.08, 95% CI, 2.51-11.22, p<0.0001 and 8.35, 95% CI, 3.35-22.39, p<0.0001, respectively), while older age patients were less likely to receive LC (OR 0.95, 95% CI, 0.94-0.98, p<0.0001). On univariate analysis, there was no significant difference seen in DFS, OS, LRFS, and DRFS between LC and SC. Similarly, in multivariate analyses comparing LC vs. SC, the course of XRT was not associated with differences in DFS (HR 1.06, 95% CI, 0.68-1.64, p=0.80), OS (HR 0.91, 95% CI, 0.61-1.37, p=0.66), LRFS (HR 0.79, 95% CI, 0.39-1.57, p=0.50) and DRFS (HR 0.99, 95% CI, 0.60-1.61, p=0.95). Additional baseline clinical and tumor characteristics did not influence outcomes (all p>0.05). Conclusions: Appropriate pre-operative selection of SC vs. LC neoadjuvant XRT for early stage RC based on patient and tumor characteristics was not associated with differences in survival outcomes.

scholarly journals Analysis of risk factors for anastomotic leakage after lower rectal Cancer resection, including drain type: a retrospective single-center study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tetsushi Kinugasa ◽  
Sachiko Nagasu ◽  
Kenta Murotani ◽  
Tomoaki Mizobe ◽  
Takafumi Ochi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Underlying Disease ◽  
Lower Rectal Cancer ◽  
Open Drainage ◽  
Related Factors ◽  
Closed Drainage ◽  
Score Analysis

Abstract Background We investigated the correlations between surgery-related factors and the incidence of anastomotic 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 enrolled in this retrospective study. Temporary ileostomy was performed in each patient. Results Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed a significant association between operative duration (p = 0.005), transanal hand-sewn anastomosis (p = 0.014), and operation procedure (p = 0.019) and the occurrence of leakage. Multivariate regression reanalysis showed that underlying disease (p = 0.044), transanal hand-sewn anastomosis (p = 0.019) and drain type (p = 0.025) were significantly associated with the occurrence of leakage. The propensity-score analysis showed that closed drainage were 6.3 times more likely to have anastomotic leakage than open drainage in relation to the amount of postoperative drainage (ml), according to the inverse probability of treatment-weighted analysis. Conclusions Our results indicate that underlying disease, transanal hand-sewn anastomosis, and closed drain may be a risk and predictive factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that closed drainage was related to the occurrence of anastomotic leakage and closed drainage was correlated with less volume of postoperative drain discharge than open drain.

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