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

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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.


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.


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


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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  1. Asoglu O, Balik E, Kunduz E, Yamaner S, Akyuz A, Gulluoglu M, et al. Laparoscopic surgery for rectal cancer: outcomes in 513 patients. World J Surg. 2013;37(4):883–92.

    Article  Google Scholar 

  2. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003;90(10):1261–6.

    Article  CAS  Google Scholar 

  3. Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, et al. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum. 2008;51(6):902–8.

    Article  Google Scholar 

  4. Kawada K, Takahashi R, Hida K, Sakai Y. Impact of transanal drainage tube on anastomotic leakage after laparoscopic low anterior resection. Int J Colorectal Dis. 2018;33(3):337–40.

    Article  Google Scholar 

  5. Kawada K, Hasegawa S, Hida K, Hirai K, Okoshi K, Nomura A, et al. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc. 2014;28(10):2988–95.

    Article  Google Scholar 

  6. Hidaka E, Ishida F, Mukai S, Nakahara K, Takayanagi D, Maeda C, et al. Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg Endosc. 2015;29(4):863–7.

    Article  Google Scholar 

  7. Okuda J, Tanaka K, Kondo K, Asai K, Kayano H, Yamamoto M, et al. Safe anastomosis in laparoscopic low anterior resection for rectal cancer. Asian J Endosc Surg. 2011;4(2):68–72.

    Article  CAS  Google Scholar 

  8. Ito T, Obama K, Sato T, Matsuo K, Inoue H, Kubota K, et al. Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg. 2017;10(1):17–22.

    Article  Google Scholar 

  9. Hasegawa S, Nagayama S, Nomura A, Kawamura J, Sakai Y. Multimedia article. Autonomic nerve-preserving total mesorectal excision in the laparoscopic era. Dis Colon Rectum. 2008;51(8):1279–82.

    Article  Google Scholar 

  10. Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Yamaguchi T, Muto T. Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc. 2008;22(2):557–61.

    Article  Google Scholar 

  11. Weykamp C. HbA1c: a review of analytical and clinical aspects. Ann Lab Med. 2013;33(6):393–400.

    Article  CAS  Google Scholar 

  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  13. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668–85.

    Article  Google Scholar 

  14. Tanaka K, Okuda J, Yamamoto S, Ito M, Sakamoto K, Kokuba Y, 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. 2017;47(10):1215–22.

    Article  Google Scholar 

  15. Park JS, Choi GS, Kim SH, Kim HR, Kim NK, Lee KY, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg. 2013;257(4):665–71.

    Article  Google Scholar 

  16. Kim JS, Cho SY, Min BS, Kim NK. Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg. 2009;209(6):694–701.

    Article  Google Scholar 

  17. Yamamoto S, Fujita S, Akasu T, Inada R, Moriya Y, Yamamoto S. Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surg Laparosc Endosc Percutan Tech. 2012;22(3):239–43.

    Article  Google Scholar 

  18. Hidaka E, Maeda C, Nakahara K, Shimada S, Mukai S, Sawada N, et al. Fecal Volume after laparoscopic low anterior resection predicts anastomotic leakage. Dig Surg. 2017;34(5):394–9.

    Article  Google Scholar 

  19. Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008;23(7):703–7.

    Article  Google Scholar 

  20. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246(2):207–14.

    Article  Google Scholar 

  21. Okoshi K, Masano Y, Hasegawa S, Hida K, Kawada K, Nomura A, et al. Efficacy of transanal drainage for anastomotic leakage after laparoscopic low anterior resection of the rectum. Asian J Endosc Surg. 2013;6(2):90–5.

    Article  Google Scholar 

  22. Parthasarathy M, Greensmith M, Bowers D, Groot-Wassink T. Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients. Colorectal Dis. 2017;19(3):288–98.

    Article  CAS  Google Scholar 

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Conflict of Interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations



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.

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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).

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