Purpose
The study was designed to identify the risk factors associated with anastomotic leakage after an intraperitoneal large-bowel anastomosis in patients with colorectal malignancy.
Methods
The prospectively collected data of patients who underwent colorectal resection for malignancy with primary anastomosis above the pelvic peritoneal reflection for malignancy between 1996 and 2004 were reviewed. Thirty-five variables were evaluated using univariate and multivariate analysis.
Results
A total of 1,417 patients were studied and anastomotic leakage occurred in 25 patients (1.8 percent). Twenty-two patients (88 percent) required reoperation for anastomotic leakage. The hospital stay (28 vs. 10 days, P < 0.001) and mortality rate (32 vs. 4 percent, P < 0.001) of patients with anastomotic leakage were significantly increased compared with those without leakage. Multivariate analysis showed that American Society of Anesthesiologists Grade 3 to 5 (P = 0.04; odds ratio, 5.6; 95 percent confidence interval, 1.6–15.3) and emergency operation (P = 0.03; odds ratio, 4.6; 95 percent confidence interval, 1.9–9.8) were independent factors associated with anastomotic leakage. The risk of anastomotic leakage was 8.1 percent (odds ratio, 10.5; 95 percent confidence interval, 2.7–26.8) if both factors were present.
Conclusions
Intraperitoneal anastomosis after large-bowel resection is associated with a low leakage rate. Emergency surgery and a high American Society of Anesthesiologists grade are independent factors associated with an increased incidence of leakage. A temporary diverting stoma to protect the primary anastomosis or even avoidance of anastomosis could be considered for patients with the two risk factors present.
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References
I Kanellos K Blouhos H Demetriades et al. (2004) ArticleTitleThe failed intraperitoneal colon anastomosis after colon resection Tech Coloproctol 8 IssueIDSuppl 1 S53–S55 Occurrence Handle15655643 Occurrence Handle10.1007/s10151-004-0111-3
WH Isbister (2001) ArticleTitleAnastomotic leak in colorectal surgery: a single surgeon’s experience ANZ J Surg 71 516–520 Occurrence Handle11527260 Occurrence Handle1:STN:280:DC%2BD3MvosFWgtA%3D%3D Occurrence Handle10.1046/j.1440-1622.2001.02189.x
WL Law KW Chu JW Ho CW Chan (2000) ArticleTitleRisk factors for anastomotic leakage after low anterior resection with total mesorectal excision Am J Surg 179 92–96 Occurrence Handle10773140 Occurrence Handle1:STN:280:DC%2BD3cvhs1Cktw%3D%3D Occurrence Handle10.1016/S0002-9610(00)00252-X
TE Pakkastie PE Luukkonen HJ Jarvinen (1994) ArticleTitleAnastomotic leakage after anterior resection of the rectum Eur J Surg 160 293–297 Occurrence Handle8075199 Occurrence Handle1:STN:280:DyaK2czlsFCgsQ%3D%3D
R Golub RW Golub R Cantu HD Stein (1997) ArticleTitleA multivariate analysis of factors contributing to leakage of intestinal anastomoses J Am Coll Surg 184 364–372 Occurrence Handle9100681 Occurrence Handle1:STN:280:DyaK2s3lsFegtg%3D%3D
A Alves Y Panis D Trancart JM Regimbeau M Pocard P Valleur (2002) ArticleTitleFactors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients World J Surg 26 499–502 Occurrence Handle11910487 Occurrence Handle10.1007/s00268-001-0256-4
E Rullier C Laurent JL Garrelon P Michel J Saric M Parneix (1998) ArticleTitleRisk factors for anastomotic leakage after resection of rectal cancer Br J Surg 85 355–358 Occurrence Handle9529492 Occurrence Handle1:STN:280:DyaK1c7ptVaruw%3D%3D Occurrence Handle10.1046/j.1365-2168.1998.00615.x
A Vignali VW Fazio IC Lavery et al. (1997) ArticleTitleFactors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients J Am Coll Surg 185 185–186 Occurrence Handle10.1016/S1072-7515(97)00061-6
ND Karanjia AP Corder P Bearn RJ Heald (1994) ArticleTitleLeakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum Br J Surg 81 1224–1226 Occurrence Handle7953369 Occurrence Handle1:STN:280:DyaK2M%2FktFWltg%3D%3D
JT Makela H Kiviniemi S Laitinen (2003) ArticleTitleRisk factors for anastomotic leakage after left sided colorectal resection with rectal anastomosis Dis Colon Rectum 46 653–660 Occurrence Handle12792443 Occurrence Handle10.1007/s10350-004-6627-9
LT Sorensen T Jorgensen LT Kirkeby J Skovdal B Vennits P Wille-Jorgensen (1999) ArticleTitleSmoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery Br J Surg 86 927–931 Occurrence Handle10417567 Occurrence Handle1:STN:280:DyaK1MzkvVKmsQ%3D%3D Occurrence Handle10.1046/j.1365-2168.1999.01165.x
KP Nugent P Daniels B Stewart R Patankar CD Johnson (1999) ArticleTitleQuality of life in stoma patients Dis Colon Rectum 42 1569–1574 Occurrence Handle10613475 Occurrence Handle1:STN:280:DC%2BD3c%2FnvVKgtA%3D%3D Occurrence Handle10.1007/BF02236209
AW Gooszen RH Geelkerken J Hermans MB Lagaay HG Gooszen (2000) ArticleTitleQuality of life with a temporary stoma Dis Colon Rectum 43 650–655 Occurrence Handle10826426 Occurrence Handle1:STN:280:DC%2BD3c3osVKmuw%3D%3D Occurrence Handle10.1007/BF02235581
WJ Mileski RJ Joehi RV Rege DL Nahrwold (1988) ArticleTitleTreatment of anastomotic leakage following low anterior colon resection Arch Surg 123 968–971 Occurrence Handle3395240 Occurrence Handle1:STN:280:DyaL1c3otVGrtA%3D%3D
JR Tuson WG Everett (1990) ArticleTitleA retrospective study of colostomies, leaks and stricture after colorectal anastomosis Int J Colorectal Dis 5 44–48 Occurrence Handle2313156 Occurrence Handle1:STN:280:DyaK3c7ovVSmuw%3D%3D Occurrence Handle10.1007/BF00496150
S Petersen M Freitag G Hellmich K Ludwig (1998) ArticleTitleAnastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer Int J Colorectal Dis 13 160–163 Occurrence Handle9810519 Occurrence Handle1:STN:280:DyaK1M%2FivVaitg%3D%3D Occurrence Handle10.1007/s003840050158
AM Akyol JR McGregor DJ Galloway GD Murray WD George (1991) ArticleTitleAnastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis 6 179–183 Occurrence Handle1770281 Occurrence Handle1:STN:280:DyaK387itFOhtA%3D%3D Occurrence Handle10.1007/BF00341385
SW Bell KG Walker MJ Richard et al. (2003) ArticleTitleAnastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence Br J Surg 90 1261–1266 Occurrence Handle14515297 Occurrence Handle1:STN:280:DC%2BD3svltl2htQ%3D%3D Occurrence Handle10.1002/bjs.4219
A Nesbakken K Nygaard OC Lunde (2001) ArticleTitleOutcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer Br J Surg 88 400–404 Occurrence Handle11260107 Occurrence Handle1:STN:280:DC%2BD3M7mtVejsw%3D%3D Occurrence Handle10.1046/j.1365-2168.2001.01719.x
A Agnifili M Schietroma A Carloni et al. (2004) ArticleTitleThe value of omentoplasty in protecting colorectal anastomosis from leakage. A prospective randomized study in 126 patients Hepatogastroenterol 51 1694–1697 Occurrence Handle1:STN:280:DC%2BD2crmtVymtQ%3D%3D
F Merad JM Hay A Fingerhut Y Flamant JM Molkhou Y Laborde (1998) ArticleTitleOmentoplasty in the prevention of anastomotic leakage after colonic or rectal resection: a prospective randomized study in 712 patients. French Associations for Surgical Research Ann Surg 227 179–186 Occurrence Handle9488514 Occurrence Handle1:STN:280:DyaK1c7kslygug%3D%3D Occurrence Handle10.1097/00000658-199802000-00005
LP Fielding S Stewart-Brown L Blesovsky G Kearney (1980) ArticleTitleAnastomotic integrity after operations for large-bowel cancer: a multicentre study BMJ 281 411–414 Occurrence Handle7427298 Occurrence Handle1:STN:280:DyaL3M%2FktFSgsg%3D%3D Occurrence Handle10.1136/bmj.281.6237.411
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Choi, HK., Law, WL. & Ho, J.W.C. Leakage After Resection and Intraperitoneal Anastomosis for Colorectal Malignancy: Analysis of Risk Factors. Dis Colon Rectum 49, 1719–1725 (2006). https://doi.org/10.1007/s10350-006-0703-2
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DOI: https://doi.org/10.1007/s10350-006-0703-2