Risk factors for anastomotic leakage in rectal cancer surgery. A retrospective cohort study (original) (raw)
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The Risk Factors of Anastomotic Leakage After Rectal Cancer Surgery
International Journal of Cancer Management
Background: Anastomotic leakage is a significant complication after colorectal anastomosis. The aim of this study was to evaluate the risk factors and preventive measures for anastomotic leakage after rectal cancer surgery. Methods: A total of 171 patients who had undergone laparoscopic and open rectal cancer resection with a double stapling participated in this study. Twelve independent variables include age, sex, obesity, smoking, ASA grading, medical diseases, preoperative radiotherapy, preoperative chemotherapy, splenic flexure mobilization, diverting ileostomy, and the number of stapler firing were analyzed. Results: The anastomotic leakage rate was 2.33% (4 of 171). The mean age of the patients was 58.33 years old while their mean body mass index (BMI) was calculated as 24.10 kg/m2. In our study, 16.3% of patients were cigarette smokers. Of the 171 rectal surgeries, 69.0% of patients were diverted by loop ileostomy and 1.16% were supported by ghost ileostomy. Of 171 patients i...
Anastomotic leakage in rectal cancer surgery: incidence and risk factors
HVM Bioflux, 2015
1Ghenadie Pascarenco, 1Marius F. Coros, 2Ofelia D. Pascarenco, 1Sorin Sorlea, 3Adrian M. Maghiar 1 IIIrd Surgical Departament, County Clinical Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania; 2 Department of Gastroenterology, County Clinical Hospital, University of Medicine and Pharmacy, Târgu Mureş, Romania; 3 University of Medicine and Pharmacy, Surgical Departament, Pelican Clinical Hospital, Oradea, Romania.
Risk factors for anastomotic leakage after resection for rectal cancer
The American Journal of Surgery, 2008
BACKGROUND: Controversy still exists concerning the impact of patient and tumor characteristics on anastomotic dehiscence after resection for rectal cancer. METHODS: Between January 1986 and July 2006, 472 patients underwent curative rectal resection. Patient and tumor characteristics, details of treatment, and postoperative results were recorded prospectively. Univariate and multivariate analysis were applied to identify risk factors for anastomotic leakage. RESULTS: In our patients, the anastomotic leak rate was 10.4% (49 of 472 patients), and mortality was 2.2% (1 of 49 patients). In univariate analysis, tumor diameter and absence of a protective stoma were associated with increased anastomotic leak rate, whereas American Society of Anesthesiologists (ASA) score and tumor localization showed borderline significance. In multivariate analysis, tumor diameter, tumor localization, and absence of a protective stoma were significantly associated with anastomotic leakage. CONCLUSIONS: Patients with large and low lying rectal tumors are at high risk for anastomotic leakage. A protective stoma significantly decreases the rate of clinical leaks and subsequent reoperation after low anterior resection.
Impact of anastomotic leakage on oncological outcome after rectal cancer resection
British Journal of Surgery, 2007
Background: Anastomotic leakage has a major impact on morbidity and mortality in rectal cancer surgery. Its relevance to oncological outcome is controversial. This observational study investigated the influence of anastomotic leakage on oncological outcome. Methods: Data for 1741 patients undergoing curative resection of rectal cancer (located less than 12 cm from the anal verge) with normal healing were compared with those for 303 patients who experienced anastomotic leakage. Morbidity, mortality and long-term oncological outcomes were analysed. Results: Median follow-up was 40 months. Patients with anastomotic leakage had a higher postoperative mortality rate than those with no leakage (4•3 versus 1•2 per cent; P < 0•001). Patients with leakage necessitating surgical treatment had a higher 5-year local recurrence rate (17•5 versus 10•1 per cent; P = 0•006) and a lower 5-year disease-free survival rate (70•9 versus 75•4 per cent; P = 0•020) than those without leakage. Patients with anastomotic leakage not requiring surgical intervention did not have a worse oncological outcome. Conclusion: A negative prognostic impact of anastomotic leakage on local recurrence and disease-free survival was found only for patients with leakage needing surgical revision.
BMC Cancer
Background The influence of anastomotic leakage (AL) on local recurrence rates and survival in rectal cancer remains controversial. The aim of this study was to analyze the effect of asymptomatic anastomotic leakage (AAL) and symptomatic anastomotic leakage (SAL) on short- and long-term outcome after curative rectal cancer resection. Methods All patients who underwent surgical resection of non-metastatic rectal cancer with curative intent from January 2005 to December 2017 were retrospectively analyzed. Short-term morbidity, long-term functional and oncological outcomes were compared between patients with SAL, AAL and without AL (WAL). Results Overall, 200 patients were included and AL was observed in 39 (19.5%) patients (10 AAL and 29 SAL) with a median follow-up of 38.5 months. Rectal cancer location and preoperative neoadjuvant treatment was similar between the three groups. Postoperative 30-day mortality rate was nil. The permanent stoma rate was higher in patients with SAL or A...
Anastomotic leakage following low anterior resection for rectal cancer
Techniques in Coloproctology, 2010
Aim Aim of this study is to present the incidence of anastomotic leakage after anterior resection for rectal cancer and to demonstrate the therapeutic approach for the treatment of this complication. Patients and methods Between 1990 and 2009, 170 patients underwent low anterior resection with total mesorectal excision (TME). Results A total of 14 (8.2%) anastomotic leaks were confirmed. Reoperation was carried out in six patients with major leaks. Eight patients with minor leaks were treated conservatively by nutritional support and antibiotic therapy. Conclusion The incidence of anastomotic leakage after anterior resection of the rectum for rectal cancer is relatively low.
Turkish Journal of Colorectal Disease, 2018
Bu çalışmanın amacı, rektum kanseri nedeniyle opere edilen hastaları anastomoz kaçağına (AK) yatkın hale getirebilecek risk faktörlerini tespit etmek ve diversiyon stomanın (DS), gelişen AK şiddetini azaltıp azaltmadığını incelemektir. Yöntem: Kliniğimizde Ocak 2010-Aralık 2016 tarihleri arasında rektum kanseri nedeniyle elektif küratif cerrahi uygulanmış hastalar çalışmaya dahil edildi. AK tanımı ve şiddeti, International Study Group of Rectal Cancer tarafından belirlenen kriterler kullanılarak belirlendi. Klinik AK saptanan hastalarda klinik, cerrahi ve patolojik sonuçlarla ile ilişkili değişkenler arasındaki ilişkiler tek değişkenli ve çok değişkenli analizle incelendi. Subgrup analizde AK tespit edilen hastalar ise DS açılan ve açılmayan şeklinde iki gruba ayrılarak incelendi.
Risk factors, short and long term outcome of anastomotic leaks in rectal cancer
Oncotarget, 2015
Background: An anastomotic leak (AL) after colorectal surgery is one major reason for postoperative morbidity and mortality. There is growing evidence that AL affects short and long term outcome. This prospective German multicentre study aims to identify risk factors for AL and quantify effects on short and long term course after rectal cancer surgery. Methods: From 1 January 2000 to 31 December 2010 381 hospitals attributed patients to the prospective multicentre study Quality Assurance in Colorectal Cancer managed by the Otto-von-Guericke-University Magdeburg (Germany). Included were 17 867 patients with histopathologically confirmed rectal carcinoma and primary anastomosis. Risk factor analysis included 13 items of demographic patient data, surgical course, hospital volume und tumour stage. Results: In 2 134 (11.9%) patients an AL was diagnosed. Overall hospital mortality was 2.1% (with AL 7.5%, without AL 1.4%; p < 0.0001). In multivariate analysis male gender, ASA-classification ≥III, smoking history, alcohol history, intraoperative blood transfusion, no protective ileostomy, UICC-stage and height of tumour were independent risk factors. Overall survival (OS) was significantly shorter for patients with AL (UICC I-III; UICC I, II or III-each p < 0.0001). Disease free survival (DFS) was significantly shorter for patients with AL in UICC I-III; UICC II or UICC III (each p < 0.001). Rate of local relapse was not significantly affected by occurrence of AL. Conclusion: In this study patients with AL had a significantly worse OS. This was mainly due to an increased in hospital mortality. DFS was also negatively affected by AL whereas local relapse was not. This emphasizes the importance of successful treatment of AL related problems during the initial hospital stay. * Chi-square test ** Mann-Whitney-U-test AL-anastomotic leakage