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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

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Abstract

Purpose

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

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan

    Keitaro Tanaka

  2. Cancer Center, Osaka Medical College Hospital, Osaka, Japan

    Junji Okuda

  3. Division of Gastroenterological Surgery, Hiratsuka City Hospital, 19-1-1, Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan

    Seiichiro Yamamoto

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

    Masaaki Ito

  5. Department of Coloproctological Surgery, Juntendo University, Tokyo, Japan

    Kazuhiro Sakamoto

  6. Department of Gastroenterological Surgery, St. Marianna University Yokohama West Hospital, Kanagawa, Japan

    Yukihito Kokuba

  7. Innovative Clinical Research Center, Kanazawa University Hospital, Ishikawa, Japan

    Kenichi Yoshimura

  8. Department of Surgery, Kitasato University Hospital, Kanagawa, Japan

    Masahiko Watanabe

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  1. Keitaro Tanaka
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  2. Junji Okuda
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Correspondence to Seiichiro Yamamoto.

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

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Tanaka, K., Okuda, J., Yamamoto, S. et al. 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. Surg Today 47, 1215–1222 (2017). https://doi.org/10.1007/s00595-017-1496-8

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