Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis

Abstract

BackgroundLaparoscopic rectal surgery involving rectal transection and anastomosis with stapling devices is technically difficult. The aim of this study was to evaluate the risk factors for anastomotic leakage (AL) after laparoscopic low anterior resection (LAR) with double-stapling technique (DST) anastomosis.MethodsThis was a retrospective single-institution study of 154 rectal cancer patients who underwent laparoscopic LAR with DST anastomosis between June 2005 and August 2013. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses. The outcome of interest was clinical AL.ResultsThe overall AL rate was 12.3 % (19/154). In univariate analysis, tumor size (P = 0.001), operative time (P = 0.049), intraoperative bleeding (P = 0.037), lateral lymph node dissection (P = 0.009), multiple firings of the linear stapler (P = 0.041), and precompression before stapler firings (P = 0.008) were significantly associated with AL. Multivariate analysis identified tumor size (odds ratio [OR] 4.01; 95 % confidence interval [CI] 1.25–12.89; P = 0.02) and precompression before stapler firings (OR 4.58; CI 1.22–17.20; P = 0.024) as independent risk factors for AL. In particular, precompression before stapler firing tended to reduce the AL occurring in early postoperative period.ConclusionsUsing appropriate techniques, laparoscopic LAR with DST anastomosis can be performed safely without increasing the risk of AL. Important risk factors for AL were tumor size and precompression before stapler firings.

Tighter formed staples produce stronger sealing against luminal leakage

“…Likewise in a clinical study, a significant factor for the reduction of risk of anastomotic leakage after low anterior resection was found to be the use of a pre-compression period prior to firing the stapler [20]. Use of pre-compression reduced the odds of leakage by more than a factor of four.…”

Anastomotic leakage rate following modified double staple technique of anterior resection with vertical division of the rectum for rectal cancer surgery

“…Recently, after Laparoscopic Low Anterior Resection (LLAR) AL occurred 12.3% among 154 patients [5]. To prevent AL after LLAR, Tetsuo Ito reported the usefulness of transanal tube [6].…”

“…Kenji Kawada found AL 19 cases of 154 rectal cancer patients (12.3%) [5]. They analyzed the tumor size and the recompression before stapler firing was risk factors for AL after laparoscopic LAR with DST anastomosis.…”

Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment

“…Tumor size is a well-known risk factor of AL after low anterior resection 26) ; in the limited working-space of the pelvis, a large tumor size adversely affects the ease of rectal division and anastomosis. Furthermore, larger tumors naturally tend to be accompanied by tumor obstruction.…”