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Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer: a propensity score matching analysis of 1014 consecutive patients

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Abstract

Background

This observational study was conducted to compare the rate of symptomatic anastomotic leakage (AL), as defined by precise criteria, between laparoscopic and open surgery in patients with mid-to-low rectal cancer using a relatively novel statistical technique.

Methods

A total of 1014 consecutive low anterior resection (LAR) patients were registered, of whom 936 were included in this prospective, multicenter, and cohort study (UMIN-CTR, Number 000004017). Patients with rectal cancer within 10 cm from the anal verge underwent either open or laparoscopic LAR at one of the 40 institutions in Japan from June 2010 to February 2013. The primary endpoint of this study was to compare the rate of symptomatic AL between the two groups before and after propensity score matching (PSM). The secondary endpoint was to analyze the risk factors for symptomatic AL in open and laparoscopic surgery.

Results

After PSM, the incidence of symptomatic AL in open and laparoscopic surgery was 12.4 and 15.3 %, respectively (p = 0.48). AL requiring relaparotomy occurred after 3.8 % of open surgeries and 6.2 % of laparoscopic surgeries (p = 0.37). Multivariate analysis identified male gender as an independent risk factor for symptomatic AL following laparoscopic surgery (p = 0.001; odds ratio 5.2; 95 % CI 2.0–13.8), and male gender (p = 0.004; odds ratio 2.6; 95 % CI 1.3–5.6), tumor size (p = 0.002; odds ratio 1.2; 95 % CI 0.7–0.9), and number of stapler firing (p = 0.04; odds ratio 4.1; 95 % CI 1.0–15.0) following open surgery.

Conclusion

The rate of symptomatic AL was comparable following laparoscopic and open LAR in this large, multicenter, cohort study after PSM. Male gender was associated with an increased risk of symptomatic AL after laparoscopic LAR.

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Acknowledgments

This study was supported by the Japanese Society for Cancer of the Colon and Rectum. Presented here is a list of the participating surgeons and centers: T. Morita (Aomori Prefectural Central Hospital, Aomori), H. Bando (Ishikawa Prefectural Central Hospital, Ishikawa), J. Okuda (Osaka Medical College Hospital, Osaka), K. Otsuka (Iwate Medical University School of Medicine, Iwate), A. Kanazawa (Japanese Red Cross Osaka Hospital, Osaka), M. Ueno (Cancer Institute Hospital, Tokyo), M. Shiozawa (Kanagawa Cancer Center, Kanagawa), M. Watanabe (Kitasato University Hospital, Kanagawa), T. Masaki (Kyorin University Hospital, Tokyo), Y. Sakai (Kyoto University Hospital, Kyoto), E. Otsuji (Kyoto Prefectural University of Medicine, Kyoto), K. Shirouzu (Kurume University Hospital, Fukuoka), T. Kusumi (Keiyukai Sapporo Hospital, Hokkaido), Y. Kinugasa (Shizuoka Cancer Center Hospital, Shizuoka), M. Morita (National Hospital Organization Kyushu Cancer Center, Fukuoka), Y. Kubo (National Hospital Organization Shikoku Cancer Center, Ehime), H. Ike (Saiseikai Nanbu Hospital, Kanagawa), H. Masuko (Sapporo-Kosei General Hospital, Hokkaido), N. Takiguchi (Chiba Cancer Center, Chiba), H. Horie (Jichi Medical University, Tochigi), K. Sugihara (Tokyo Medical and Dental University, Tokyo), S. Kameoka (Tokyo Women’s Medical University Hospital, Tokyo), Y. Takii (Niigata Cancer Center Hospital, Niigata), F. Itani (Fukuyama City Hospital, Hiroshima), N. Tomita (Hyogo College of Medicine, Hyogo), M. Okajima (Hiroshima City Asa Hospital, Hiroshima), T. Sato (Yamagata Prefectural Central Hospital, Yamagata), S. Osada (Yokohama City Minato Red Cross Hospital, Kanagawa), M. Ohue (Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka), S. Fujii (Yokohama City University Medical Center, Kanagawa), H. Yamaue (Wakayama Medical University, Wakayama), and M. Hamada (Kochi Health Sciences Center, Kochi). The authors thank Keita Mori of the Biostatistics Collaboration Unit, Shizuoka Cancer Center, Japan, for his help with statistical analyses.

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Authors and Affiliations

  1. Departments of Surgery, Fujita Health University School of Medicine, Hidetoshi Katsuno Dengakugakubo 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Hidetoshi Katsuno, Yoshikazu Koide & Koutarou Maeda

  2. Division of Colorectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan

    Akio Shiomi

  3. Division of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan

    Masaaki Ito & Norio Saito

  4. Division of Colorectal Surgery, Saitama Cancer Center, Saitama, Japan

    Toshimasa Yatsuoka

  5. Departments of Surgery, National Defence Medical College Hospital, Saitama, Japan

    Kazuo Hase

  6. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Toyoake, Aichi, Japan

    Koji Komori

  7. Division of Colorectal Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Kazuhito Minami

  8. Departments of Surgery, Juntendo University Hospital, Tokyo, Japan

    Kazuhiro Sakamoto

  9. Departments of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan

    Yoshihisa Saida

Authors
  1. Hidetoshi Katsuno
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  2. Akio Shiomi
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  12. Norio Saito
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Corresponding author

Correspondence to Hidetoshi Katsuno.

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Disclosures

Drs. Hidetoshi Katsuno, Akio Shiomi, Masaaki Ito, Yoshikazu Koide, Koutarou Maeda, Toshimasa Yatsuoka, Kazuo Hase, Koji Komori, Kazuhito Minami, Kazuhiro Sakamoto, Yoshihisa Saida, and Norio Saito have no conflicts of interest or financial ties to disclose.

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Katsuno, H., Shiomi, A., Ito, M. et al. Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer: a propensity score matching analysis of 1014 consecutive patients. Surg Endosc 30, 2848–2856 (2016). https://doi.org/10.1007/s00464-015-4566-2

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