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Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer

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Abstract

Background and aims

Clinical anastomotic leakage remains a major problem after anterior or low anterior resection for rectal cancer. The aim of this study was to assess the association between risk factors and anastomotic leakage and postoperative mortality.

Materials and methods

Two hundred seventy-six elective anterior or low anterior resections with anastomosis were performed and documented on-line from January 1995 to December 2004. Univariate and multivariate analyses with Bonferroni adjustment were carried out to identify relevant risk factors.

Results

The rate of anastomotic leakage was 14.9% (41 of 276 patients) with a mortality of 12.2% (5 of 41 patients). Overall mortality was 2.5% (7 of 276 patients). Multiple regression analysis showed that smokers had an increased risk of anastomotic leakage [odds ratio (OR), 6.42; 95% confidence interval (CI), 2.68–15.36] as well as patients with coronary heart disease (OR, 7.79; 95% CI, 2.52–24.08). Smokers (OR, 13.20; 95% CI, 2.48–7.24) and patients with coronary heart disease (OR, 23.46; 95% CI, 4.33–27.04) also had an increased risk of postoperative mortality in the univariate analysis as well as patients with anastomotic leakage (OR, 16.25; 95% CI, 3.04–16.92).

Conclusions

Smoking and coronary heart disease are important risk factors for anastomotic leakage and postoperative mortality after elective resection for rectal cancer.

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References

  1. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  PubMed  CAS  Google Scholar 

  2. Averbach AM, Chang D, Koslowe P, Sugarbaker PH (1996) Anastomotic leak after double-stapled low colorectal resection. Dis Colon Rectum 39:780–787

    Article  PubMed  CAS  Google Scholar 

  3. Law WI, Chu KW, Ho JW, Chan CW (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96

    Article  PubMed  CAS  Google Scholar 

  4. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469

    Article  PubMed  CAS  Google Scholar 

  5. Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, Rutten HJ, van de Velde CJ (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92:211–216

    Article  PubMed  CAS  Google Scholar 

  6. Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P (1999) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86:927–931

    Article  PubMed  CAS  Google Scholar 

  7. Agnifili A, Schietroma M, Carloni A, Mattucci S, Caterino G, Lygidakis NJ, Carlei F (2004) The value of omentoplasty in protecting colorectal anastomosis from leakage. A prospective randomized study in 126 patients. Hepatogastroenterology 51:1694–1697

    PubMed  CAS  Google Scholar 

  8. Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, Bokey EL (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240:255–259

    Article  PubMed  Google Scholar 

  9. Akyol AM, McGregor JR, Galloway DJ, Murray GD, George WD (1991) Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis 6:179–183

    Article  PubMed  CAS  Google Scholar 

  10. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266

    Article  PubMed  CAS  Google Scholar 

  11. Fujita S, Teramoto T, Watanabe M, Kodaira S, Kitajima M (1993) Anastomotic leakage after colorectal cancer surgery: a risk factor for recurrence and poor prognosis. Jpn J Clin Oncol 23:299–302

    PubMed  CAS  Google Scholar 

  12. Petersen S, Freitag M, Hellmich G, Ludwig K (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 13:160–163

    Article  PubMed  CAS  Google Scholar 

  13. Branagan G, Finnis D (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48:1021–1026

    Article  PubMed  Google Scholar 

  14. Hallbook O, Sjodahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83:60–62

    Article  PubMed  CAS  Google Scholar 

  15. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  16. Luna-Perez P, Rodriguez-Ramirez SE, Gutierrez de la Barrera M, Labastida S (2002) [Multivariate analysis of risk factors associated with dehiscence of colorectal anastomosis after anterior or lower anterior resection for sigmoid or rectal cancer]. Rev Invest Clin 54:501–508

    PubMed  Google Scholar 

  17. Poon RT, Law WL, Chu KW, Wong J (1998) Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg 85:1539–1542

    Article  PubMed  CAS  Google Scholar 

  18. Fazio VW, Tekkis PP, Remzi F, Lavery IC (2004) Assessment of operative risk in colorectal cancer surgery: the Cleveland Clinic Foundation colorectal cancer model. Dis Colon Rectum 47:2015–2024

    Article  PubMed  Google Scholar 

  19. Alberts JC, Parvaiz A, Moran BJ (2003) Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis 5:478–482

    Article  PubMed  CAS  Google Scholar 

  20. Kasperk R, Philipps B, Vahrmeyer M, Willis S, Schumpelick V (2000) [Risk factors for anastomosis dehiscence after very deep colorectal and coloanal anastomosis]. Chirurg 71:1365–1369

    Article  PubMed  CAS  Google Scholar 

  21. Galloway JM (2002) The epidemiology of atherosclerosis and its risk factors among native Americans. Curr Diab Rep 2:274–281

    Article  PubMed  Google Scholar 

  22. Lehr HA (2000) Microcirculatory dysfunction induced by cigarette smoking. Microcirculation 7:367–384

    Article  PubMed  CAS  Google Scholar 

  23. Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82

    Article  PubMed  CAS  Google Scholar 

  24. Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113

    PubMed  CAS  Google Scholar 

  25. Anonymous (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet 356:968–974

    Article  Google Scholar 

  26. Eckmann C, Kujath P, Schiedeck TH, Shekarriz H, Bruch HP (2004) Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 19:128–133

    Article  PubMed  CAS  Google Scholar 

  27. Kruschewski M, Germer CT, Rieger H, Buhr HJ (2002) [Radical resection of colorectal carcinoma in the oldest old]. Chirurg 73:241–244

    Article  PubMed  CAS  Google Scholar 

  28. Tonus C, Keller O, Kropp R, Nier H (1996) [Colorectal carcinoma. Which factors are decisive for development of postoperative complications?]. Langenbecks Arch Surg 381:251–257

    CAS  Google Scholar 

  29. Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268

    Article  PubMed  Google Scholar 

  30. Hallbook O, Pahlman L, Krog M, Wexner SD, Sjodahl R (1996) Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 224:58–65

    Article  PubMed  CAS  Google Scholar 

  31. Hallbook O, Johansson K, Sjodahl R (1996) Laser Doppler blood flow measurement in rectal resection for carcinoma-comparison between the straight and colonic J pouch reconstruction. Br J Surg 83:389–392

    Article  PubMed  CAS  Google Scholar 

  32. Lustosa SA, Matos D, Atallah AN, Castro AA (2001) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 3:CD003144

    PubMed  Google Scholar 

  33. Everett WG, Friend PJ, Forty J (1986) Comparison of stapling and hand-suture for left-sided large bowel anastomosis. Br J Surg 73:345–348

    Article  PubMed  CAS  Google Scholar 

  34. Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ (1995) Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 221:176–184

    Article  PubMed  CAS  Google Scholar 

  35. Laurent A, Parc Y, McNamara D, Parc R, Tiret E (2005) Colonic J-pouch-anal anastomosis for rectal cancer: a prospective, randomized study comparing handsewn vs. stapled anastomosis. Dis Colon Rectum 48:729–734

    Article  PubMed  Google Scholar 

  36. Wong NY, Eu KW (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 48:2076–2079

    Article  PubMed  CAS  Google Scholar 

  37. Poon RT, Chu KW, Ho JW, Chan CW, Law WL, Wong J (1999) Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 23:463–467 (discussion 467–468)

    Article  PubMed  CAS  Google Scholar 

  38. Dehni N, Schlegel RD, Cunningham C, Guiguet M, Tiret E, Parc R (1998) Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 85:1114–1117

    Article  PubMed  CAS  Google Scholar 

  39. Ohman U, Svenberg T (1983) EEA stapler for mid-rectum carcinoma. Review of recent literature and own initial experience. Dis Colon Rectum 26:775–784

    Article  PubMed  CAS  Google Scholar 

  40. Graffner H, Fredlund P, Olsson SA, Oscarson J, Petersson BG (1983) Protective colostomy in low anterior resection of the rectum using the EEA stapling instrument. A randomized study. Dis Colon Rectum 26:87–90

    Article  PubMed  CAS  Google Scholar 

  41. Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142

    Article  PubMed  CAS  Google Scholar 

  42. Killingback M, Barron P, Dent O (2002) Elective resection and anastomosis for colorectal cancer: a prospective audit of mortality and morbidity 1976-1998. ANZ J Surg 72:689–698

    Article  PubMed  Google Scholar 

  43. Damhuis RA, Wereldsma JC, Wiggers T (1996) The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer. Int J Colorectal Dis 11:45–48

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We thank Priv.-Doz. Dr. med. Dr. rer. nat. Werner Hopfenmüller, Institute of Medical Informatics, Biometry and Epidemiology, Charité-Medical School, Campus Benjamin Franklin, for his support in working up the statistical data.

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Authors and Affiliations

  1. Department of Surgery, Charité-Medical School, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    Martin Kruschewski, Hayo Rieger, Uwe Pohlen, Hubert G. Hotz & Heinz J. Buhr

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  1. Martin Kruschewski
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  2. Hayo Rieger
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Correspondence to Martin Kruschewski.

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Kruschewski, M., Rieger, H., Pohlen, U. et al. Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22, 919–927 (2007). https://doi.org/10.1007/s00384-006-0260-0

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