Risk Factors for Anastomotic Leakage after Low Anterior Resection

Introduction: Low anterior resection (LAR) is a standard surgical procedure for distal rectal carcinoma that allows creation of a colorectal anastomosis, with anal sphincter preservation and permanent colostomy avoidance. Anastomotic leakage (AL) is a potential complication of LAR present in 3% to 20% of cases leading to a significant increase in postoperative morbidity. AL represents a communication between the intra luminal and extra luminal compartments caused by a violation of the integrity of the intestinal wall. The risk factors of this procedure have been discussed and still remain a controversial issue. Prevention is the best management. Patients with predisposing factors should be paid special attention. Aim: Our objective was to identify and analyze the risk factors of anastomotic leakage after low anterior resection of rectal carcinoma. Patients and methods: This study included all patients who underwent low anterior resection for rectal cancer at the Department of Surgery of University Hospital Kaspela between 2011 and 2016. Results: Low anterior resections were performed in 141 patients during the study period. Due to a positive air leak test on 16 patients, a protective ileostomy was created and these patients were eliminated from the study. The sex distribution of the remaining 125 patients was 69 men (55.2%) and 56 women (44.8%). The height of the anastomosis from the dentate line was 3.0 cm on an average (range 2.5 to 4 cm). Conclusion: Anastomotic leakage remains the most feared and serious complication after low anterior resection surgery. The evidence suggests that the main risk factors for anastomotic leakage at low anterior resection are the height of the anastomosis and the high ASA score.

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Two dominant patterns of low anterior resection syndrome and their effects on patients’ quality of life

Scientific Reports ◽

10.1038/s41598-021-82149-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min Jung Kim ◽

Ji Won Park ◽

Mi Ae Lee ◽

Han-Ki Lim ◽

Yoon-Hye Kwon ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Anterior Resection ◽

Low Anterior Resection ◽

University Hospital ◽

Postoperative Treatment ◽

Low Anterior Resection Syndrome ◽

Cross Sectional ◽

Anterior Resection Syndrome

AbstractTo identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504–43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504–43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100–4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

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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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Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer

FUKUSHIMA JOURNAL OF MEDICAL SCIENCE ◽

10.5387/fms.2019-17 ◽

2020 ◽

Vol 66 (1) ◽

pp. 10-16

Author(s):

Wataru Sakamoto ◽

Shinji Ohki ◽

Tomohiro Kikuchi ◽

Hirokazu Okayama ◽

Shotaro Fujita ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Prognostic Score ◽

Glasgow Prognostic Score ◽

Modified Glasgow Prognostic Score ◽

Rectal Transection

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Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

World Journal of Gastroenterology ◽

10.3748/wjg.v22.i25.5718 ◽

2016 ◽

Vol 22 (25) ◽

pp. 5718 ◽

Cited By ~ 32

Author(s):

Kenji Kawada ◽

Yoshiharu Sakai

Keyword(s):

Risk Factors ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Double Stapling Technique ◽

Laparoscopic Low Anterior Resection ◽

Stapling Technique ◽

Postoperative Risk ◽

Double Stapling

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

Annals of Coloproctology ◽

10.3393/ac.2019.11.19.1 ◽

2020 ◽

Vol 36 (3) ◽

pp. 192-197 ◽

Cited By ~ 1

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%.

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Low Anterior Resection Syndrome in Adults with Rectal Cancer in China: a Case Series Analysis

Indian Journal of Surgery ◽

10.1007/s12262-021-02745-x ◽

2021 ◽

Author(s):

Yuan Qiu ◽

Yu Pu ◽

Haidi Guan ◽

Weijie Fan ◽

Shuai Wang ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Recovery Time ◽

Colorectal Anastomosis ◽

Postoperative Recovery ◽

Low Anterior Resection Syndrome ◽

Anterior Resection Syndrome ◽

Lars Score

AbstractLow anterior resection syndrome (LARS) comprises a collection of symptoms affecting patients’ defecation after restorative surgery for rectal cancer. The aim of this work was to study the incidence and risk factors for LARS in China. Rectal cancer patients undergoing total mesorectal excision and colorectal anastomosis between May 2012 and January 2015 were identified from a single center. The patients completed the LARS score questionnaire through telephone. The clinical and pathological factors that may influence the occurrence of LARS were analyzed using univariate and multivariate logistic regression analysis. The influence of postoperative recovery time and pelvic dimensions on the occurrence of LARS was also analyzed. This study included 337 patients, at an average age of 61.03 SD11.32. The mean LARS score of the patients was 14.08 (range 0–41). A total of 126 patients (37.4%) developed LARS after surgery, including 63 (18.7%) severe cases. Compared with the scores within the initial 6 postoperative months, the LARS scores of the patients in 6~18 months after the surgery showed significant reductions (p < 0.01). In multivariate analysis, lower locations of anastomosis, pre-surgery radiotherapy, and shorter postoperative recovery time were significant predisposing factors for LARS. A subgroup analysis revealed that patients suffering from LARS over 18 months after surgery were found to have a significantly shorter interspinous distance than those without LARS (p < 0.05). LARS could improve over time after surgery. Lower anastomotic level and pre-surgery radiotherapy are risk factors for LARS.

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

Journal of the Korean Society of Coloproctology ◽

10.3393/jksc.2007.23.5.365 ◽

2007 ◽

Vol 23 (5) ◽

pp. 365 ◽

Cited By ~ 3

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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METHOD OF «HIDDEN COLOSTOMY» IN LOW ANTERIOR RESECTIONS OF RECTUM

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2016-175-6-52-55 ◽

2016 ◽

Vol 175 (6) ◽

pp. 52-55

Author(s):

E. A. Kalivo ◽

G. M. Manikhas ◽

M. D. Khanevich ◽

M. Kh. Fridman ◽

G. N. Khrykov

Keyword(s):

Anastomotic Leakage ◽

Large Intestine ◽

Anterior Resection ◽

Low Anterior Resection ◽

Colorectal Anastomosis ◽

Rectal Anastomosis ◽

Intestinal Stoma ◽

Dressing Room

The authors present their experience, methodology and advantages of the method of «hidden colostomy» in treatment of anastomotic leakage after low anterior resection of rectum. The operations using the method of «hidden colostomy» were performed on 67 patients. All the patients underwent the low anterior resection of rectum operation concerning cancer with anastomosis formation at the distance of 3-8 cm from anus. The leakage of rectal anastomosis was revealed in 6 (8,9%) patients. A delayed double-barrel transverse stoma using preventive turnpike was formed in surgical dressing room without typical relaparotomy according to described method. Continuity of large intestine was restored in all patients during 2 months after operation. The method of «hidden colostomy» allowed doctors to avoid formation of vain protective intestinal stoma. This method helped to treat patients in a very simple and effective way in case of leakage of colorectal anastomosis.

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