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Retrospective Risk Analysis for Anastomotic Leakage Following Laparoscopic Rectal Cancer Surgery in a Single Institute

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Abstract

Purpose

Anastomotic leakage (AL) is one of the most serious complications after laparoscopic low anterior resection (LALAR) for rectal cancer. The aim of the present study was to investigate the risk factors for AL after LALAR.

Methods

A retrospective study was conducted of 103 patients who underwent LALAR in a single institute between October 2008 and January 2018. Univariate and multivariate analyses were performed to determine the clinicopathological factors associated with AL.

Results

The overall incidence of AL was 9.7% (10/103). After anastomosis using the double-stapling technique, a transanal tube was placed in 88 patients (85.4%). A diverting stoma was created in 26 patients (25.2%). The univariate analysis showed that a younger age (P = 0.014), higher stage (P = 0.048), deeper depth of tumor invasion (P = 0.028), larger tumor circumference (P = 0.024), longer operation time (P = 0.015), and early postoperative diarrhea (P = 0.002) were associated with AL. The multivariate logistic regression analysis revealed early postoperative diarrhea (odds ratio [OR] 16.513, 95% confidence interval [CI] 2.393–113.971, P = 0.004) a younger age (10-year increments; OR 0.351, 95% CI 0.147–0.839, P = 0.019), operative time (10-min increments; OR 1.089, 95% CI 1.012–1.172, P = 0.022), and higher stage (OR 10.605, 95% CI 1.279–87.919, P = 0.029) were independent risk factors for AL

Conclusion

Our findings suggest that tumor progression accompanied by a high stage, long operative time, and insufficient bowel preparation and early postoperative diarrhea due to a large tumor circumference may be risk factors of AL after LALAR for rectal cancer.

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Conflict of Interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 849-8571, Japan

    Masatsugu Hiraki, Toshiya Tanaka, Osamu Ikeda, Naoya Kimura, Satomi Nakamura, Hiroaki Nakamura, Kohei Yamada, Keiichiro Okuyama, Koutaro Yamaji, Atsushi Miyoshi, Kenji Kitahara & Seiji Sato

  2. Life Science Research Institution, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 849-8571, Japan

    Eiji Sadashima

  3. Department of Surgery, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Sag City, Saga, 849-8501, Japan

    Tatsuya Manabe & Hirokazu Noshiro

Authors
  1. Masatsugu Hiraki
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  2. Toshiya Tanaka
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  3. Osamu Ikeda
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  4. Eiji Sadashima
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  5. Naoya Kimura
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  6. Satomi Nakamura
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  7. Hiroaki Nakamura
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  8. Kohei Yamada
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  9. Keiichiro Okuyama
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  10. Koutaro Yamaji
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  11. Tatsuya Manabe
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  12. Atsushi Miyoshi
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  13. Kenji Kitahara
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  14. Seiji Sato
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  15. Hirokazu Noshiro
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Contributions

M Hiraki and T Toshiya designed this study. M Hiraki, T Toshiya, O Ikeda, N Kimura, S Nakamura, H Nakamura, K Yamada, K Okuyama, K Yamaji, A Miyoshi, K Kitahara, and S Sato treated the patients. M Hiraki and E Sadashima analyzed the data. M Hiraki, T Tanaka, T Manabe, and H Noshiro interpreted the result and wrote the manuscript.

Corresponding author

Correspondence to Masatsugu Hiraki.

Ethics declarations

All patients and their families were informed about the surgical procedure and provided their written consent. Informed broad consent for this study was obtained. The medical ethics committee of Saga Medical Center Koseikan reviewed and approved this study design (permission number: 18-07-01-01).

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Hiraki, M., Tanaka, T., Ikeda, O. et al. Retrospective Risk Analysis for Anastomotic Leakage Following Laparoscopic Rectal Cancer Surgery in a Single Institute. J Gastrointest Canc 51, 908–913 (2020). https://doi.org/10.1007/s12029-019-00315-9

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  • DOI: https://doi.org/10.1007/s12029-019-00315-9

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