Surgical-related risk factors associated with anastomotic leakage after resection for rectal cancer: a meta-analysis

Abstract

Objectives Anastomotic leakage (AL) after anterior resection always leads to longer hospital stays, decreased quality of life and even increased mortality. Despite extensive research, no consensus on the world well-concerned surgical-related risk factors exists. We therefore conducted a meta-analysis of the available published literature to identify the effects of surgical-related risk factors for AL after anterior resection for rectal cancer, hoping to provide more information and improved guidance for clinical workers managing patients with rectal cancer who are at a high risk for AL. Methods In this study, the relevant articles were systematically searched from EMBASE, MEDLINE, PubMed, WangFang (Database of Chinese Ministry of Science & Technology), Chinese National Knowledge Infrastructure Database and China Biological Medicine Database. The pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Meta-analysis was performed using of RevMan 5.3 software. Results A total of 26 studies met the inclusion criteria and comprised 34238 cases. Analysis of these 26 studies showed that no defunctioning stoma was highly correlated with AL (pooled OR = 1.28, 95%CI: 1.05–1.57, P = 0.01, random effect), and intraoperative blood transfusion was significantly associated with AL (pooled OR = 1.64, 95%CI: 1.34–2.02, P = 0.02, random effect). However, the AL was not associated with type of anastomosis, type of surgery, technique of anastomosis, level of inferior mesenteric artery ligation, operation time and splenic flexure mobilization. Conclusions Depend on this meta-analysis, no defunctioning stoma and intraoperative blood transfusion are the major surgical-related risk factors for AL after resection for rectal cancer. Because of the inherent limitations of the research, future prospective randomized controlled trials will need to confirm this conclusion.

Machine learning-based random forest predicts anastomotic leakage after anterior resection for rectal cancer

“…Consistently, our study showed that male patients and those with lower distance of tumor from the anal verge were more likely to have AL. Similarly, preoperative bowel stenosis or obstruction, preoperative anemia (<90 g/L) or massive blood loss during operation, diabetes, and nCRT that were also considered as predictors in our study, have also been reported in several other studies (19,29). A proximal bowel stenosis or even obstruction may induce the proximal and distal bowel tissue edema, and thus increase the incidence of AL after AR.…”

“…In addition to the above predictive factors, we also found that surgeon volume, and surgical approach was related to the incidence of AL. It was argued that low volume surgeons were more likely to incur AL (29,30), and we found the same conclusion. However, when it comes to surgical approach, except open surgery (12,29), performing laparoscopic surgery in first year could also raise the incidence of AL.…”

“…It was argued that low volume surgeons were more likely to incur AL (29,30), and we found the same conclusion. However, when it comes to surgical approach, except open surgery (12,29), performing laparoscopic surgery in first year could also raise the incidence of AL. This result indicates that we cannot neglect the human factor in high volume surgeons and laparoscopic learning curve may contribute to AL (30)(31)(32).…”

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

“…Two previous studies revealed that an appropriate defunctioning stoma significantly decreases the occurrence of AL in high-risk patients [ 7 , 19 ]. A recent high-quality meta-analysis involving 23 observational studies further concluded that no defunctioning stoma was a significant surgical related risk factor for AL [ 21 ]. However, Shiomi [ 22 ] and Salamone [ 8 ] reported that a defunctioning stoma did not decrease the occurrence of AL but did mitigate the clinical features and reoperation rate.…”

Risk Factors of Symptomatic Anastomotic Leakage and its Impacts on Long Term&nbsp;Survival after Laparoscopic Low Anterior Resection for Rectal Cancer:&nbsp;A Retrospective Single Center Study

“…Two previous studies revealed that an appropriate defunctioning stoma signi cantly decreases the occurrence of AL in high-risk patients [7,19]. A recent high-quality meta-analysis involving 23 observational studies further concluded that no defunctioning stoma was a signi cant surgical related risk factor for AL [21]. However, Shiomi [22] and Salamone [8] reported that a defunctioning stoma did not decrease the occurrence of AL but did mitigate the clinical features and reoperation rate.…”