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