Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: The Korean laparoscopic colorectal surgery study group

Jun Seok Park, Gyu Seog Choi, Seon Hahn Kim, Hyeong Rok Kim, Nam Kyu Kim, Kang Young Lee, Sung Bum Kang, Ji Yeon Kim, Kil Yeon Lee, Byung Chun Kim, Byung Noe Bae, Gyung Mo Son, Sun Il Lee, Hyun Kang

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158 Citations (Scopus)

Abstract

OBJECTIVE: To assess the risk factors for clinical anastomotic leakage (AL) in patients undergoing laparoscopic surgery for rectal cancer. BACKGROUND: Little data are available about risk factors for AL after laparoscopic rectal cancer resection. METHODS: This was a retrospective analysis of 1609 patients with rectal cancer who had undergone laparoscopic surgery for rectal cancer with sphincter preservation. Clinical data related to AL were collected from 11 institutions. Univariate and multivariate analyses were performed to determine the risk factors for AL. RESULTS: AL was noted in 101 (6.3%) of the patients. The leakage rate ranged from 2.0% to 10.3% for each hospital (P = 0.04). In patients without protective stomas (n = 1187), male sex [hazard ratio (HR), 3.468], advanced tumor stage (HR, 2.520), lower tumor level (HR, 2.418), preoperative chemoradiation (HR, 6.284), perioperative transfusion (HR, 10.705), and multiple firings of the linear stapler (HR, 6.181) were significantly associated with AL. Our theoretical model suggested that the HR for patients with 2 risk factors was significantly higher than that the HR for patients with no or only 1 risk factor. CONCLUSIONS: Male sex, low anastomosis, preoperative chemoradiation, advanced tumor stage, perioperative bleeding, and multiple firings of the linear stapler increased the risk of AL after laparoscopic surgery for rectal cancer. A diverting stoma might be mandatory in patients with 2 or more of the risk factors identified in this analysis.

Original languageEnglish
Pages (from-to)665-671
Number of pages7
JournalAnnals of surgery
Volume257
Issue number4
DOIs
Publication statusPublished - 2013 Apr

Keywords

  • anastomotic leakage
  • laparoscopic surgery
  • rectal cancer
  • risk factor

ASJC Scopus subject areas

  • Surgery

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    Park, J. S., Choi, G. S., Kim, S. H., Kim, H. R., Kim, N. K., Lee, K. Y., Kang, S. B., Kim, J. Y., Lee, K. Y., Kim, B. C., Bae, B. N., Son, G. M., Lee, S. I., & Kang, H. (2013). Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: The Korean laparoscopic colorectal surgery study group. Annals of surgery, 257(4), 665-671. https://doi.org/10.1097/SLA.0b013e31827b8ed9