Skip to main content

Multicenter analysis of risk factors for anastomotic leakage after middle and low rectal cancer resection without diverting stoma: a retrospective study of 319 consecutive patients

International Journal of Colorectal Disease volume 32, pages 1431–1437 (2017)Cite this article

Abstract

Purpose

The purpose of this study was to evaluate the risk factors for anastomotic leakage (AL) after anterior resection for middle and low rectal cancer in order to help surgeons to decide which patients could benefit from a diverting stoma.

Methods

Data on 319 patients having a middle and low rectal cancer resection with anastomosis between May 2011 and October 2015 from two hospitals were included in the study. The analysis included the following variables: patient-related variables (gender, age, diabetes mellitus, ASA score, preoperative radiochemotherapy, body mass index, blood hemoglobin, and serum albumin level), tumor-related variables (K-ras status, distance of tumor from the anal verge, histopathologic grade, pathological T stage, pathological N stage, pathological M stage, TNM stage, and tumor size), and surgery-related variables (laparoscopic or open surgery, blood loss, and operative time). Univariate and multivariate regression analysis were carried out to identify risk factors for AL.

Results

The AL rate was 11.91% (38/319). Male (OR 2.898, 95% CI 1.265–6.637, p = 0.012), diabetes mellitus (OR 2.482, 95% CI 1.004–6.134, p = 0.049), K-ras mutation (OR 2.544, 95% CI 1.210–5.348, p = 0.014), distance of tumor from the anal verge (OR 3.445, 95% CI 1.631–7.279, p = 0.001), and preoperative radiochemotherapy (OR 2.790, 95% CI 1.056–7.372, p = 0.039) were independent risk factors of AL. One (2.63%) in 38 patients with AL presented with no risk factor of AL, 6 (15.8%) in 38 patients with 1 risk factor, 16 (42.1%) in 38 patients with 2 risk factors, 9 (23.7%) in 38 patients with 3 risk factors, and 6 (15.7%) in 38 patients with 4 risk factors. No patient with 5 risk factors in our study. AL rate increased with the elevated number of risk factors clustering in individuals.

Conclusions

K-ras mutation is first reported to be an independent risk factor for AL after sphincter-preserving surgery without diverting stoma. A diverting stoma should be performed in sphincter-preserving surgery for middle and low rectal cancer patients with 2 or more risk factors identified in this analysis.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Jannasch O, Klinge T, Otto R, Chiapponi C, Udelnow A, Lippert H, Bruns CJ, Mroczkowski P (2015) Risk factors, short and long term outcome of anastomotic leaks in rectal cancer. Oncotarget 6(34):36884–36893. doi:10.18632/oncotarget.5170

    PubMed  PubMed Central  Google Scholar 

  2. Vinodkumar N, Khan ZA (2009) Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 96(9):1066–1075. doi:10.1002/bjs.6694

    Article  Google Scholar 

  3. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2015) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253(5):890–899. doi:10.1097/SLA.0b013e3182128929

    Article  Google Scholar 

  4. Vasiliu EC, Zarnescu NO, Costea R, Neagu S (2015) Review of risk factors for anastomotic leakage in colorectal surgery. Chirurgia (Bucur) 110(4):319–326

    Google Scholar 

  5. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102(5):462–479. doi:10.1002/bjs.9697

    CAS  Article  PubMed  Google Scholar 

  6. Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F (2007) Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg 94(3):341–345. doi:10.1002/bjs.5621

    CAS  Article  PubMed  Google Scholar 

  7. Koyama M, Murata A, Sakamoto Y, Morohashi H, Hasebe T, Saito T, Hakamada K (2016) Risk factors for anastomotic leakage after intersphincteric resection without a protective defunctioning stoma for lower rectal cancer. Ann Surg Oncol Suppl 2:S249–S256. doi:10.1245/s10434-015-4461-z

    Article  Google Scholar 

  8. Parthasarathy M, Greensmith M, Bowers D, Groot-Wassink T (2017) Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17518 patients. Colorectal Dis 19(3):288–298. doi:10.1111/codi.13476

    CAS  Article  PubMed  Google Scholar 

  9. Hu MH, Huang RK, Zhao RS, Yang KL, Wang H (2017) Does neoadjuvant therapy increase the incidence of anastomotic leakage after anterior resection for mid and low rectal cancer?A systematic review and meta-analysis. Colorectal Dis 19(1):16–26. doi:10.1111/codi.13424

    Article  PubMed  Google Scholar 

  10. Ren J, Li G, Ge J, Li X, Zhao Y (2012) Is K-ras gene mutation a prognostic factor for colorectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 55(8):913–923. doi:10.1097/DCR.0b013e318251d8d9

    Article  PubMed  Google Scholar 

  11. Vincenzi B, Cremolini C, Sartore-Bianchi A, Russo A, Mannavola F, Perrone G, Pantano F, Loupakis F, Rossini D, Ongaro E, Bonazzina E, Dell'Aquila E, Imperatori M, Zoccoli A, Bronte G, De Maglio G, Fontanini G, Natoli C, Falcone A, Santini D, Onetti-Muda A, Siena S, Tonini G, Aprile G (2015) Prognostic significance of K-Ras mutation rate in metastatic colorectal cancer patients. Oncotarget 6(31):31604–31612. doi:10.18632/oncotarget.5231

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rui Y, Wang C, Zhou Z, Zhong X, Yu Y (2015) K-Ras mutation and prognosis of colorectal cancer: a meta-analysis. Hepatogastroenterology 62(137):19–24

    CAS  PubMed  Google Scholar 

  13. Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W (2017) Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg 41(1):277–284. doi:10.1007/s00268-016-3761-1

    Article  PubMed  Google Scholar 

  14. Warschkow R, Steffen T, Thierbach J, Bruckner T, Lange J, Tarantino I (2011) Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol 18(10):2772–2782. doi:10.1245/s10434-011-1696-1

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Wei Zhang, Zheng Lou, and Qizhi Liu contributed equally to this work and are considered co-first authors.

Affiliations

  1. Department of Colorectal Surgery, Changhai Hospital, Changhai Road 168#, Shanghai, China

    Wei Zhang, Zheng Lou, Qizhi Liu, Ronggui Meng, Haifeng Gong, Liqiang Hao, Peng Liu, Ge Sun, Jun Ma & Wei Zhang

  2. Department of Gastrointestinal Surgery, People’s Hospital of Henan Province, Weiwu Road 7#, Zhengzhou, China

    Wei Zhang

Authors
  1. Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zheng Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qizhi Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronggui Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haifeng Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liqiang Hao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Peng Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ge Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jun Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Zhang.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhang, W., Lou, Z., Liu, Q. et al. Multicenter analysis of risk factors for anastomotic leakage after middle and low rectal cancer resection without diverting stoma: a retrospective study of 319 consecutive patients. Int J Colorectal Dis 32, 1431–1437 (2017). https://doi.org/10.1007/s00384-017-2875-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2875-8

Keywords

  • Rectal cancer
  • Diverting stoma
  • Anastomotic leakage
  • Risk factor
  • K-ras