Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer

Abstract

BackgroundAnastomotic leakage (AL) is the most serious and common complication of surgery for rectal cancer, and associated risk factors remain unknown despite developments in laparoscopic surgery. The present study aimed to determine risk factors for AL after laparoscopic anterior resection (AR) of rectal cancer.MethodsThis retrospective cohort study extracted information from a prospective database of all consecutive colorectal resections that proceeded at Nippon Medical School Hospital between January 2011 and December 2015 (n = 865). We identified 154 patients with rectal cancer treated by elective laparoscopic AR with anastomosis using primary double-stapling. Clinical variables and comorbidity, habits, and surgery-related variables were assessed by univariate and multivariate analyses to determine preoperative risk factors for clinical AL.ResultsThe overall rate of clinical AL was 11.7% (18 of 154 patients), and 5 (27.8%) of 18 patients required revised laparotomy. Data from males were analyzed because AL occurred only in males. Univariate analysis of male patients (n = 100) significantly associated preoperative creatinine values (p = 0.03) and a history of ischemic heart disease (IHD) (p = 0.012) with AL. The frequency of AL tended to increase (p = 0.06) when patients had low AR (p = 0.06) and transanal drainage. Having AL significantly prolonged hospital stays compared with patients without leakage (36.2 vs. 11.1 days; p < 0.01). Multivariate analysis identified a history of IHD (odds ratio [OR], 4.73; 95% confidence interval [CI], 1.27–17.5; p = 0.025] as an independent risk factor for AL.ConclusionsMale sex and a history of IHD are possible risk factors for AL after elective laparoscopic rectal cancer surgery.

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

“…In addition, a poorer blood supply caused by a lower anastomotic level might be another reason for the high risks of AL. We also explored the relationship between AL and tumor location, but no statistically significant differences were observed, which was in line with some previous reports [35]. Given the difference about the length of the distal margin from the low border of the rectal tumor between tumors located above and tumors located below the peritoneal reflection, we believe the level of anastomosis may be a better index to predict AL than tumor location.…”

Evaluating the predictive factors for anastomotic leakage after total laparoscopic resection with transrectal natural orifice specimen extraction for colorectal cancer

“…The prolongation of operation time is often associated with some unfavorable conditions, such as in obese male patients, in patients with tissue edema after radiotherapy, or in patients with previous cardiovascular diseases 4,17‐20 . Consistent with results of the above literature, our results show that patients undergoing transrectal NOSE have similar risk factors for AL.…”

Determining the protective characteristics and risk factors for the development of anastomotic leakage after low anterior resection for rectal cancer

“…According to those studies, the preoperative and intraoperative risk factors included the sex, operation time, and amount of intraoperative blood loss [13,14]. Several studies have concluded that male sex is a risk factor for AL [24,25]. Similarly, the findings of our analysis also indicated that males were at a significant risk of developing AL.…”