Risk factors of symptomatic anastomotic leakage and its impacts on a long-term survival after laparoscopic low anterior resection for rectal cancer: a retrospective single-center study

Abstract

Background Postoperative symptomatic anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) for rectal cancer. AL can potentially affect short-term patient outcomes and long-term prognosis. This study aimed to explore the risk factors and long-term survival of symptomatic AL after laparoscopic LAR for rectal cancer. Methods From May 2009 to May 2015, 298 consecutive patients who underwent laparoscopic LAR for rectal cancer with or without a defunctioning stoma were included in this study. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for symptomatic AL. Survival analysis was performed using Kaplan–Meier curves, and log-rank tests were used for group comparisons. Results Among the 298 patients enrolled in this study, symptomatic AL occurred in eight (2.7%) patients. The univariate analysis showed that age of ≤65 years (P = 0.048), neoadjuvant therapy (P = 0.095), distance from the anal verge (P = 0.078), duration of operation (P = 0.001), and pathological tumor (T) category (P = 0.004) were associated with symptomatic AL. The multivariate analysis demonstrated that prolonged duration of operation (P = 0.010) was an independent risk factor for symptomatic AL after laparoscopic LAR for rectal cancer. No statistically significant differences were observed in the 3-year (P = 0.785) and 5-year (P = 0.979) overall survival rates. Conclusions A prolonged duration of operation increased the risk of symptomatic AL after laparoscopic LAR for rectal cancer. An impact of symptomatic AL on a long-term survival was not observed in this study; however, further studies are required. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033413) on May 31, 2020.

The relationship between the psoas muscle mass index and postoperative complications in Crohn's Disease : A retrospective cohort study

“…In our study, the operative time and a low PMI were identi ed as risk factors for postoperative complications in a univariate analysis, while a low-PMI was the only independent predictor in a multivariate analysis. The relationship between operative time and complications is one of the most commonly discussed issues in gastrointestinal surgery [14][15][16]. In addition, although our study did not nd signi cant differences, the ECCO-ESCP consensus on Crohn's disease surgery reported that anti-TNF agents increased the risk of postoperative sepsis, intra-abdominal abscess, anastomotic leakage, wound infection, and rehospitalization in patients with Crohn's disease.…”

The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

“…Clinically significant anastomotic leakage for laparoscopic rectal cancer surgery usually occurs on the 7th day post-surgery [ 35 ]. Generally, the small anastomotic leakage can be treated through conservative treatment (fasting water, nutritional support, anti-inflammation, fluid replacement), while the severe clinically significant anastomotic leakage requires surgical intervention [ 36 ]. We mainly focused on whether protective ileostomy can decrease the rate of clinically significant anastomotic leak, and tiny leaks are not evaluated in any studies.…”

“…Second, the surgeons have a clinical bias in performing protective ileostomy for patients receiving laparoscopic rectal cancer surgery possibly. Many different factors can influence the clinically significant anastomotic leakage rate, such as anastomotic position, sex, tumor diameter, operation time, location of ligation IMA, and postoperative management [ 36 , 45 , 46 ]. Therefore, there is bias in choosing ileostomy for patients receiving laparoscopic rectal cancer surgery.…”

Role of the triad of procalcitonin, C-reactive protein, and white blood cell count in the prediction of anastomotic leak following colorectal resections

“…Moreover, it can give a maximum discriminatory value for AL diagnosis when combined with the 5-day trajectories of CRP and WBC. In terms of WBC as AL marker, it was not a point of investigation by some researchers [ 45 , 46 ] or it has been reported that there was no relation to AL, however, they have included only symptomatic AL patients and isolated values rather than trajectory [ 47 , 48 ]. PCT has also been investigated recently as an early marker for septic complications after surgery.…”