Risk Factors of Anastomotic Leakage After Anterior Resection for Rectal Cancer Patients

Abstract

Objective

Anastomotic leakage (AL) is one of the serious complications after anterior resection for rectal cancer. Defunctioning stoma (DS) is one of the most widely used approaches to prevent it; however, the effect of DS on the occurrence of AL remains controversial. This study aimed to investigate risk factors of AL and assess the effect of DS after anterior resection for rectal cancer patients.

Methods

A retrospective analysis was conducted for the data of 1840 patients who underwent anterior resection for rectal cancer from January 2014 to December 2019.

Results

The results showed the overall AL incidence was 7.5%. Multivariate analyses revealed that males [odds ratio (OR) 1.562] and T3–T4 stage (OR 1.729) were independent risk factors for all patients. After propensity score matching analysis, the AL incidence was 14.1% in the group with no DS and 6.4% in the DS group (P<0.001). The clinical AL (grade B + grade C) incidence was 12.4% in no DS group and 4.6% in the DS group (P<0.001).

Conclusion

The study suggested that males and T3–T4 stage were independent risk factors of AL. In addition, DS could reduce the rate of symptomatic AL.

Keywords

anastomotic leakage / risk factor / defunctioning stoma / propensity score matching

References

[1] DegiuliM, ElmoreU, De LucaR, et al.. Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group. Colorectal Dis, 2022, 24(3): 264-276

[2] HoshinoN, HidaK, SakaiY, et al.. Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer. Int J Colorectal Dis, 2018, 33(4): 411-418

[3] HainE, MaggioriL, ManceauG, et al.. Oncological impact of anastomotic leakage after laparoscopic mesorectal excision. Br J Surg, 2017, 104(3): 288-295

[4] van WorkumF, TalboomK, HanninkG, et al.. Treatment of anastomotic leakage after rectal cancer resection: The TENTACLE-Rectum study. Colorectal Dis, 2021, 23(4): 982-988

[5] TsaiYY, ChenWT. Management of anastomotic leakage after rectal surgery: a review article. J Gastrointest Oncol, 2019, 10(6): 1229-1237

[6] KinugasaT, NagasuS, MurotaniK, et al.. Analysis of risk factors for anastomotic leakage after lower rectal Cancer resection, including drain type: a retrospective single-center study. BMC Gastroenterol, 2020, 20(1): 315

[7] BoströmP, HaapamäkiMM, RutegårdJ, et al.. Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer. BJS Open, 2018, 3(1): 106-111

[8] KonishiT, WatanabeT, KishimotoJ, et al.. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg, 2006, 202(3): 439-444

[9] AlvesA, PanisY, TrancartD, et al.. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg, 2002, 26(4): 499-502

[10] KarimA, CubasV, ZamanS, et al.. Anastomotic leak and cancer-specific outcomes after curative rectal cancer surgery: a systematic review and meta-analysis. Tech Coloproctol, 2020, 24(6): 513-525

[11] KoedamTWA, BootsmaBT, DeijenCL, et al.. Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence. Ann Surg, 2022, 275(2): e420-e427

[12] PisarskaM, GajewskaN, MałczakP, et al.. Defunctioning ileostomy reduces leakage rate in rectal cancer surgery — systematic review and meta-analysis. Oncotarget, 2018, 9(29): 20816-20825

[13] ParkJS, ChoiGS, KimSH, et al.. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4): 665-671

[14] RahbariNN, WeitzJ, HohenbergerW, et al.. Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer. Surgery, 2010, 147(3): 339-351

[15] PeetersKC, TollenaarRA, MarijnenCA, et al.. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg, 2005, 92(2): 211-216

[16] KaranjiaND, CorderAP, BearnP, et al.. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg, 1994, 81(8): 1224-1226

[17] van RooijenSJ, JongenAC, WuZQ, et al.. Definition of colorectal anastomotic leakage: A consensus survey among Dutch and Chinese colorectal surgeons. World J Gastroenterol, 2017, 23(33): 178-186

[18] SparreboomCL, van GroningenJT, LingsmaHF, et al.. Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit. Dis Colon Rectum, 2018, 61(11): 1258-1266

[19] ShinjiS, UedaY, YamadaT, et al.. Male Sex and History of Ischemic Heart Disease Are Major Risk Factors for Anastomotic Leakage After Laparoscopic Anterior Resection in Patients With Rectal Cancer. BMC Gastroenterol, 2018, 18(1): 117

[20] ZhuQL, FengB, LuAG, et al.. Laparoscopic low anterior resection for rectal carcinoma: complications and management in 132 consecutive patients. World J Gastroenterol, 2010, 16(36): 4605-4610

[21] QuH, LiuY, BiDS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc, 2015, 29(12): 3608-3617

[22] KawadaK, HasegawaS, HidaK, et al.. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc, 2014, 28(10): 2988-2995

[23] MatsuzakiH, IshiharaS, KawaiK, et al.. Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment. J Anus Rectum Colon, 2018, 1(1): 7-14

[24] Goshen-GottsteinE, ShapiroR, ShwartzC, et al.. Incidence and Risk Factors for Anastomotic Leakage in Colorectal Surgery: A Historical Cohort Study. Isr Med Assoc J, 2019, 21(11): 732-737

[25] SørensenLT, JørgensenT, KirkebyLT, et al.. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg, 1999, 86(7): 927-931

[26] KimCW, BaekSJ, HurH, et al.. Anastomotic Leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery. Ann Surg, 2016, 263(1): 130-137

[27] GreiffensteinP, MolinaPE. Alcohol-Induced Alterations on Host Defense After Traumatic Injury. J Trauma, 2008, 64(1): 230-240

[28] SzaboG, MandrekarP. A Recent Perspective on Alcohol, Immunity, and Host Defense. Alcohol Clin Exp Res, 2009, 33(2): 220-232

[29] AkaiA, ZenkeY, MenukiK, et al.. Current Smoking Is Associated with Delayed Wound Healing But Not with Improvement of Contracture after the Open Palm Technique for Dupuytren’s Disease. J Hand Surg Asian Pac Vol, 2019, 24(1): 65-71

[30] MillsE, EyawoO, LockhartI, et al.. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med, 2011, 124(2): 144-154

[31] ParkJH, OhKS, KimTM, et al.. Effect of Smoking on Healing Failure After Rotator Cuff Repair. Am J Sports Med, 2018, 46(12): 2960-2968

[32] ChenH, MaB, GaoP, et al.. Laparoscopic intersphincteric resection versus an open approach for low rectal cancer: a meta-analysis. World J Surg Oncol, 2017, 15(1): 229

[33] van der PasMH, HaglindE, CuestaMA, et al.. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol, 2013, 14(3): 210-218

[34] KatsunoH, ShiomiA, ItoM, et al.. Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. Surg Endosc, 2016, 30(7): 2848-2856

[35] KangJ, YoonKJ, MinBS, et al.. The impact of robotic surgery for mid and low rectal cancer: a case-matched analysis of a 3-arm comparison-open, laparoscopic, and robotic surgery. Ann Surg, 2013, 257(1): 95-101

[36] LiY, WangJ, MaX, et al.. A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer. Int J Biol Sci, 2016, 12(8): 1022-1031

[37] QinQ, MaT, DengY, et al.. Impact of Preoperative Radiotherapy on Anastomotic Leakage and Stenosis After Rectal Cancer Resection: Post Hoc Analysis of a Randomized Controlled Trial. Dis Colon Rectum, 2016, 59(10): 934-942

[38] ParkJS, ChoiGS, KimSH, et al.. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4): 665-671

[39] Sebag-MontefioreD, StephensRJ, SteeleR, et al.. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet, 2009, 373(9666): 811-820

[40] ChangJS, KeumKC, KimNK, et al.. Preoperative chemoradiotherapy effects on anastomotic leakage after rectal cancer resection: a propensity score matching analysis. Ann Surg, 2014, 259(3): 516-521

[41] ShiomiA, ItoM, MaedaK, et al.. Effects of a Diverting Stoma on Symptomatic Anastomotic Leakage after Low Anterior Resection for Rectal Cancer: A Propensity Score Matching Analysis of 1,014 Consecutive Patients. J Am Coll Surg, 2015, 220(2): 186-194

[42] Lee BC, Lim SB, Lee JL, et al. Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage after Low Anterior Resection in Rectal Cancer Patients. Ann Coloproctol, 2020. doi:https://doi.org/10.3393/ac.2019.11.19.1

[43] PalumboP, UsaiS, PansaA, et al.. Anastomotic Leakage in Rectal Surgery: Role of the Ghost Ileostomy. Anticancer Res, 2019, 39(6): 2975-2983

[44] NiuL, WangJ, ZhangP, et al.. Protective ileostomy does not prevent anastomotic leakage after anterior resection of rectal cancer. J Int Med Res, 2020, 48(8): 300060520946520

[45] WuSW, MaCC, YangY. Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis. World J Gastroenterol, 2014, 20(47): 18031-18037

[46] KawadaK, SakaiY. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J Gastroenterol, 2016, 22(25): 5718-5727

[47] ZhaoWT, LiNN, HeD, et al.. Transanal Tube for the Prevention of Anastomotic Leakage After Rectal Cancer Surgery: A Systematic Review and Meta-analysis. World J Surg, 2017, 41(1): 267-276