• 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, and Hyun Kang.
• Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea. kyuschoi@mail.knu.ac.kr
• Ann. Surg.. 2013 Apr 1;257(4):665-71.

ObjectiveTo assess the risk factors for clinical anastomotic leakage (AL) in patients undergoing laparoscopic surgery for rectal cancer.BackgroundLittle data are available about risk factors for AL after laparoscopic rectal cancer resection.MethodsThis 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.ResultsAL 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.ConclusionsMale 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.

14 keywords...

hide…