Risk factors for anastomotic leakage following rectal resection – Multicenter study
Authors:
J. Kotoč 1; K. Kotočová 1; J. Gatěk 1; A. Vrzgula 2; V. Pribula 2; M. Hladík 3; J. Olejník 3
Authors‘ workplace:
Chirurgické oddělení, Nemocnice Atlas, a. s., Zlín, primář: MUDr. J. Gatěk, Ph. D
1; Chirurgická klinika LF UPJŠ, Nemocnica Košice-Šaca, a. s., 1. súkr. nemocnica, Košice-Šaca
přednosta: MUDr. A. Vrzgula, PhD.
2; Chirurgická klinika SZU, Nemocnica akademika L. Dérera, Bratislava, přednosta: prof. MUDr. J. Olejník, PhD.
3
Published in:
Rozhl. Chir., 2014, roč. 93, č. 12, s. 578-582.
Category:
Original articles
Overview
Introduction:
Anastomotic insufficiency (anastomotic leakage) is one of the most serious complications of the sphincter-saving rectal resections, with significant impact on patient morbidity and mortality. The risk rate of anastomotic leakage may be influenced by local anatomic conditions – tumour localisation and stage, possible technical problems in anastomosis construction (ischaemia, anastomosis under tension), and by complex factors associated with the patient – malnutrition, obesity, smoking, corticosteroid therapy and preoperative chemoradiation.
Material and methods:
All sphincter-saving rectal resections that were performed between September 2011 and April 2014 in three centres of colorectal surgery, i.e. at Atlas Hospital in Zlín, the Czech Republic, and at Košice-Šaca Hospital and Dérer’s University Hospital in Bratislava, Slovakia, were included in the present multicentric prospective study. The incidence of anastomotic leakage in laparoscopic and open surgery was compared and the risk factors resulting in leakage occurrence were analyzed.
Results:
Anastomotic leakage developed in 12 (10.9%) out of the total number of 110 patients. In the laparoscopic group (58 patients), the insufficiency occurred 4x (6.9%), in the 17 converted patients 3x (17.6%), and in the open surgery group (35 patients) the leakage occurred 5x (14.3%). There was no statistically significant difference between these groups. Nevertheless, patients with anastomotic leakage were only males (P=0.006), they had significantly lower pre-operative albumin levels (35.8 g/l vs. 38.3 g/l; P=0.03), as well as a lower pre-operative total protein level (60.8 g/l vs. 64.1 g/l; P=0.07), when compared to patients without insufficiency. Tumour distance from the anal verge in patients with anastomotic leakage was also significantly lower (10.8 cm vs. 12.8 cm; P=0.05).
Conclusion:
The following risk factors for anastomotic insufficiency after rectal surgery were identified: male gender, low pre-operative albumin and total protein levels, as well as decreasing tumour distance from the anal verge. The difference in the incidence of anastomotic insufficiency between laparoscopic and open surgery groups was not statistically significant.
Key words:
anastomotic leakage – rectal resection – risk factors
Sources
1. Cong ZJ, Fu CG, Wang HT, et al. Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg 2009;33:1292–1297.
2. Fouda E, El Nakeeb A, Magdy A, et al. Early detection of anastomotic leakage after elective low anterior resection. J Gastrointest Surg 2011;15:137–144.
3. Taflampas P, Christodoulakis M, Tsiftsis DD. Anastomotic leakage after low anterior resection for rectal cancer: facts, obscurity and fiction. Surg Today 2009;39:183–188.
4. Shin US, Kim CW, Yu CS, et al. Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer. Int J Colorectal Dis 2010;25:843–849.
5. Weidenhagen R, Spelsberg F, Strauss T, et al. Anastomoseninsuffizienz in der kolorektalen Chirurgie. Viszeralchirurgie 2007;42:165–172.
6. Paun BC, Cassie S, MacLean AR, et al. Postoperative complication following surgery for rectal cancer. Ann Surg 2010;251:807–818.
7. Eckmann C, Kujath P, Schiedeck THK, et al. Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 2004;19:128–133.
8. 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 2007;22:919–927.
9. Guňková P, Guňka I, Martínek L, et al. Vliv dehiscence anastomózy na onkologické výsledky u resekčních výkonů pro karcinom rekta. Rozhl Chir 2013;92:244–249.
10. Akiyoshi T, Ueno M, Fukunaga Y, et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Am J Surg 2011;202:259–264.
11. Telem DA, Chin EH, Nguyen SQ, et al. Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg 2010;145:371–376.
12. Dekker JW, Liefers GJ, de Mol van Otterloo JC, et al. Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J Surg Res 2011; 166:27–34.
13. den Dulk M, Witvliet MJ, Kortram K, et al. The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak. Colorectal Dis 2013;15:528–533.
14. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005;365:1718–1726.
15. van den Pas MH, Haglind E, Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013;14:210–218.
16. Eriksen MT, Wibe A, Norstein J, et al. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005;7:51–57.
17. Jung SH, Yu CS, Choi PW, et al. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum 2008;51:902–908.
18. Kim CW, Kim JH, Yu CS, et al. Complications after sphincter-saving resection in rectal cancer patients according to whether chemoradiotherapy is performed before or after surgery. Int J Radiat Oncol Biol Phys 2010;78:156–163.
19. Yeh CY, Changchien CR, Wang JY, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 2005;241:9–13.
20. Matthiessen P, Hallböök O, Rutegård J, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 2007;246:207–214.
21. Kotoč J, Gatěk J, Vrzgula A, et al. Komplikácie nízkych resekcií konečníka (multicentrická štúdia). Slovenská chirurgia 2013;10:135–138.
22. Trastulli S, Cirocchi R, Listorti C, et al. Laparoscopic vs open resection for rectal cancer: a meta-analysis of randomized clinical trials. Colorectal Dis 2012;14:277–296.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2014 Issue 12
Most read in this issue
- Popliteal artery entrapment syndrome
- Complicated mesenteric ischaemia
- Transanal total mesorectal excision for rectal cancer – just a fashion trend?
- Predicting pN positivity in T3 rectal cancer