A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma.

Zhi-Jie Wang,Qian Liu

doi:10.1155/2020/4863542

Abstract

Background Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality. Moreover, it might be associated with a worse oncological prognosis of tumors. This study is aimed at exploring the risk factors for symptomatic AL after laparoscopic anterior resection (LAR) for rectal tumors without a preventive diverting stoma. Materials and Methods This case control study retrospectively reviewed the data of 496 consecutive patients who underwent LAR of the rectum without a preventive diverting stoma at the Cancer Hospital, Chinese Academy of Medical Sciences between September 2016 and September 2017. All patients were divided into an AL group and a control group based on the occurrence of postoperative symptomatic AL. Factors regarding patient-related variables, operation-related variables, and tumor-related variables were collected and assessed between the two groups through univariate and multivariate logistic regression analyses to identify independent risk factors for AL. Results In total, 18 (3.6%) patients developed postoperative symptomatic AL. Univariate analysis showed that a synchronous primary malignancy of the left hemicolon (P = 0.047), intraoperative chemotherapy (P = 0.003), and level of anastomosis (P = 0.033) were significantly related with AL. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P = 0.011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P = 0.013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P = 0.030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Conclusions Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma.

Highlights

Anastomotic leakage (AL) is defined as a defect of the intestinal wall integrity at the anastomotic site, which leads to communication between the lumen of the bowel and the pelvic cavity (Figure 1)
Three (16.7%) AL patients were classified as grade B, whereas 15 (83.3%) were classified as grade C according to the proposal by the International Study Group of Rectal Cancer in 2010
To adjust for confounding bias, we further enrolled these and other variables that were previously thought to increase the risks of AL in a subsequent multivariate analysis and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P = 0:011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P = 0:013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P = 0:030) were independent risk factors for AL (Table 5)

Summary

Introduction

Anastomotic leakage (AL) is defined as a defect of the intestinal wall integrity at the anastomotic site, which leads to communication between the lumen of the bowel and the pelvic cavity (Figure 1). Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality It might be associated with a worse oncological prognosis of tumors. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P = 0:011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P = 0:013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P = 0:030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma

Objectives

Methods

Results

Conclusion