Surgery Today

, Volume 47, Issue 10, pp 1215–1222 | Cite as

Risk factors for anastomotic leakage after laparoscopic surgery with the double stapling technique for stage 0/I rectal carcinoma: a subgroup analysis of a multicenter, single-arm phase II trial

  • Keitaro Tanaka
  • Junji Okuda
  • Seiichiro YamamotoEmail author
  • Masaaki Ito
  • Kazuhiro Sakamoto
  • Yukihito Kokuba
  • Kenichi Yoshimura
  • Masahiko Watanabe
Original Article



The aim of this study was to determine the risk factors for anastomotic leakage after laparoscopic rectal surgery.


We conducted a prospective trial involving 395 patients with stage 0/I rectal carcinoma who underwent laparoscopic low anterior resection using a double stapling technique. Data concerning variables related to patient background, tumors and surgical factors were evaluated. The outcomes with respect to anastomotic leakage were recorded, and univariate and multivariate analyses were performed to identify relevant risk factors.


The overall anastomotic leakage rate was 8.4%. A univariate analysis showed male gender (P = 0.006) and preoperative blood sugar level (P = 0.0034) to be significantly associated with anastomotic leakage. The variables of gender, preoperative blood sugar level, American Society of Anesthesiologists (ASA) classification (P = 0.15), transanal decompression tube (P = 0.06) and number of stapler cartridges used for rectal transection (P = 0.18) were selected for the multivariate analysis because of their P values being <0.2. The multivariate analysis identified male gender (odds ratio 4.12, P = 0.006) and the absence of a transanal decompression tube (odds ratio 3.11, P = 0.0484) as independent risk factors predicting anastomotic leakage.


Male gender and the absence of a transanal decompression tube appeared to be independent risk factors for anastomotic leakage. Insertion of a transanal decompression tube may help prevent anastomotic leakage after low anterior resection, particularly in male patients.


Anastomotic leakage Laparoscopic surgery Rectal carcinoma Transanal decompression tube Multicenter study 



The authors thank all the participating patients and their families, as well as the investigators, research nurses, study coordinators, and operations staff. This study was funded by the Japanese Society for Cancer of the Colon and rectum. The participating centers are as follows: Iwate Medical University School of Medicine, Iwate; Sendai Medical Center, Miyagi; Jichi Medical School, Tochigi; Jichi Medical School Omiya Medical Center, Saitama; Saitama Medical University International Medical Center, Saitama, National Cancer Center Hospital East, Chiba; Juntendo University Urayasu Hospital, Chiba; Juntendo University Faculty of Medicine, Tokyo; Cancer Institute Ariake Hospital, Tokyo; National Cancer Center Hospital, Tokyo; Keio University School of Medicine, Tokyo; Tokyo Medical and Dental University, Tokyo; Toho University School of Medicine Ohashi Hospital, Tokyo; Saiseikai Wakakusa Hospital, Kanagawa; Yokohama City University, Kanagawa; Showa University Northern Yokohama Hospital, Kanagawa; Kitasato University Hospital, Kanagawa; St. Marianna Medical College, Kanagawa; Nagano Municipal Hospital, Nagano; Ishikawa Prefectural Central Hospital, Ishikawa; Shizuoka Cancer Center, Shizuoka; Fujita Health University, Aichi; Kyoto Prefecture Medical College, Kyoto; Kyoto Medical Center, Kyoto, Kyoto University Faculty of Medicine, Kyoto; Bell-land General Hospital, Osaka; Osaka Red-cross Hospital, Osaka; Osaka University Graduate School of Medicine, Faculty of Medicine, Osaka; Osaka City Juso Hospital, Osaka; Osaka Medical Center, Osaka; Osaka Medical College, Osaka; Suita Municipal Hospital, Osaka; Minou Municipal Hospital, Osaka; Nishinomiya Municipal Hospital, Hyogo; Fukuyama Municipal Hospital, Hiroshima; Hiroshima University Faculty of Medicine, Hiroshima, Shikoku Cancer Center, Ehime; Kochi University Faculty of Medicine, Kochi; Kochi Medical Center, Kochi; Tokushima University Hospital, Tokushima; Yamaguchi University Faculty of Medicine, Yamaguchi; Kyusyu University Hospital, Fukuoka; and Oita University Faculty of Medicine, Oita.

Compliance with ethical standards

Conflict of interest

Keitaro Tanaka and the other co-authors have no conflicts of interest.


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Copyright information

© Springer Japan 2017

Authors and Affiliations

  • Keitaro Tanaka
    • 1
  • Junji Okuda
    • 2
  • Seiichiro Yamamoto
    • 3
    Email author
  • Masaaki Ito
    • 4
  • Kazuhiro Sakamoto
    • 5
  • Yukihito Kokuba
    • 6
  • Kenichi Yoshimura
    • 7
  • Masahiko Watanabe
    • 8
  1. 1.Department of General and Gastroenterological SurgeryOsaka Medical CollegeOsakaJapan
  2. 2.Cancer CenterOsaka Medical College HospitalOsakaJapan
  3. 3.Division of Gastroenterological SurgeryHiratsuka City HospitalHiratsukaJapan
  4. 4.Colorectal Surgery DivisionNational Cancer Center Hospital EastChibaJapan
  5. 5.Department of Coloproctological SurgeryJuntendo UniversityTokyoJapan
  6. 6.Department of Gastroenterological SurgerySt. Marianna University Yokohama West HospitalKanagawaJapan
  7. 7.Innovative Clinical Research CenterKanazawa University HospitalIshikawaJapan
  8. 8.Department of SurgeryKitasato University HospitalKanagawaJapan

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