The Risk Factors of Anastomotic Leakage After Rectal Cancer Surgery (original) (raw)
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Risk factors for anastomotic leakage in rectal cancer surgery. A retrospective cohort study
Research Square (Research Square), 2022
PURPOSE Anastomotic leakage after restorative surgery for rectal cancer is associated with signi cant morbidity and mortality. Several factors have been identi ed as risk factors for anastomotic leakage. In this retrospective cohort study, we examined cases of anastomotic leakage in rectal surgery and tried to ascertain the risk factors. METHODS A review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated to identify risk factors for anastomotic leakage. RESULTS The overall incidence of anastomotic leakage was 10.4%, with a mean time interval of 6.2 +/-2.1 days. Overall mortality was 0.8%. Mortality was higher in patients with anastomotic leakage (4.9%) than in patients without leak (0.4%, P =0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index <40 points, tumour diameter and intraoperative blood loss were identi ed as risk factors for anastomotic leakage. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to anastomotic leakage in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube signi cantly did. CONCLUSION Clinical, surgical and pathological factors are associated with an increased risk of anastomotic leakage. It adversely affects the morbidity and mortality of rectal cancer patients.
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...
Techniques in Coloproctology, 2008
univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity. Results There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07). Conclusions Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies.
Anterior resection for rectal carcinoma - risk factors for anastomotic leaks and strictures
World journal of gastroenterology : WJG, 2011
To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection (AR) and its subsequent management. Retrospective analysis of data from 108 patients with rectal carcinoma who underwent AR or low anterior resection (LAR) to identify the various preoperative, operative, and post operative factors that might have influence on anastomotic leaks and strictures. There were 68 males and 40 females with an average of 47 years (range 21-75 years). The median distance of the tumor from the anal verge was 8 cm (range 3-15 cm). Sixty (55.6%) patients underwent handsewn anastomosis and 48 (44.4%) were stapled. The median operating time was 3.5 h (range 2.0-7.5 h). Sixteen (14.6%) patients had an anastomotic leak. Among these, 11 patients required re-exploration and five were managed expectantly. The anastomotic leak rate was similar in patients with and without diverting stoma (8/60, 13.4% with stoma and 8/48; 16.7% without stoma). In 15 (13.9%...