Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer
Abstract Background In recent years, laparoscopic surgery has been widely used for rectal cancer. In laparoscopic rectal surgery, a double-stapling technique (DST) anastomosis using a stapling device is considered a relatively difficult procedure. Postoperative anastomotic leakage (AL) is a major co...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-11-01
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| Series: | World Journal of Surgical Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12957-019-1716-3 |
| _version_ | 1818126302514774016 |
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| author | Masahiro Fukada Nobuhisa Matsuhashi Takao Takahashi Hisashi Imai Yoshihiro Tanaka Kazuya Yamaguchi Kazuhiro Yoshida |
| author_facet | Masahiro Fukada Nobuhisa Matsuhashi Takao Takahashi Hisashi Imai Yoshihiro Tanaka Kazuya Yamaguchi Kazuhiro Yoshida |
| author_sort | Masahiro Fukada |
| collection | DOAJ |
| description | Abstract Background In recent years, laparoscopic surgery has been widely used for rectal cancer. In laparoscopic rectal surgery, a double-stapling technique (DST) anastomosis using a stapling device is considered a relatively difficult procedure. Postoperative anastomotic leakage (AL) is a major complication related to patients’ quality of life and prognosis. Methods This study was a retrospective, single-institution study of 101 rectal cancer patients who underwent laparoscopic low anterior resection (LAR) with DST anastomosis (excluding simultaneous resection of other organs and construction of protective diverting stoma) between February 2008 and November 2017 at the Gifu University Graduate School of Medicine. This study aimed to identify risk and early predictive factors of AL. Results Among 101 patients, symptomatic AL occurred in 13 patients (12.9%), of whom 10 were male and 3 were female. Their median BMI was 22.7 kg/m2 (range, 17.9–26.4 kg/m2). Among the pre- and intraoperative factors, AL was significantly associated with tumor location (lower rectum), distance from the anal verge (< 6 cm), intraoperative blood loss (≥ 50 ml), and the number of linear staples (≥ 2) in univariate analysis. In multivariate analysis, only intraoperative blood loss (≥ 50 ml, odds ratio [OR] 4.59; 95% confidence interval [CI] 1.04–19.52; p = 0.045) was identified as an independent risk factor for AL. Among the postoperative factors, AL was significantly associated with tachycardia-POD1 (≥ 100 bpm), CRP-POD3 (≥ 15 mg/dl), fever on postoperative day (fever-POD) 3 (≥ 38 °C), and first defecation day after surgery (< POD3) in univariate analysis. In multivariate analysis, fever-POD3 (≥ 38 °C, OR 30.97; 95% CI 4.68–311.22; p = 0.0003) and first defecation day after surgery (< POD3, OR 5.82; 95% CI 1.34–31.30; p = 0.019) were identified as early predictive factors for AL. Conclusion In this study, intraoperative blood loss was an indicator of difficulty in a transection and anastomosing procedure, and fever-POD3 and early first defecation day after surgery were independent early predictive factors for AL. Careful surgery using an appropriate technique and standardized procedures with minimal bleeding and careful postoperative management paying attention to fever and defecation may prevent the onset and severity of AL. |
| first_indexed | 2024-12-11T06:59:18Z |
| format | Article |
| id | doaj.art-bddaabb8b47b41749008fde8d76c8995 |
| institution | Directory Open Access Journal |
| issn | 1477-7819 |
| language | English |
| last_indexed | 2024-12-11T06:59:18Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Surgical Oncology |
| spelling | doaj.art-bddaabb8b47b41749008fde8d76c89952022-12-22T01:16:40ZengBMCWorld Journal of Surgical Oncology1477-78192019-11-0117111010.1186/s12957-019-1716-3Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancerMasahiro Fukada0Nobuhisa Matsuhashi1Takao Takahashi2Hisashi Imai3Yoshihiro Tanaka4Kazuya Yamaguchi5Kazuhiro Yoshida6Department of Surgical Oncology, Graduate School of Medicine, Gifu UniversityDepartment of Surgical Oncology, Graduate School of Medicine, Gifu UniversityDepartment of Surgical Oncology, Graduate School of Medicine, Gifu UniversityDepartment of Surgical Oncology, Graduate School of Medicine, Gifu UniversityDepartment of Surgical Oncology, Graduate School of Medicine, Gifu UniversityDepartment of Surgical Oncology, Graduate School of Medicine, Gifu UniversityDepartment of Surgical Oncology, Graduate School of Medicine, Gifu UniversityAbstract Background In recent years, laparoscopic surgery has been widely used for rectal cancer. In laparoscopic rectal surgery, a double-stapling technique (DST) anastomosis using a stapling device is considered a relatively difficult procedure. Postoperative anastomotic leakage (AL) is a major complication related to patients’ quality of life and prognosis. Methods This study was a retrospective, single-institution study of 101 rectal cancer patients who underwent laparoscopic low anterior resection (LAR) with DST anastomosis (excluding simultaneous resection of other organs and construction of protective diverting stoma) between February 2008 and November 2017 at the Gifu University Graduate School of Medicine. This study aimed to identify risk and early predictive factors of AL. Results Among 101 patients, symptomatic AL occurred in 13 patients (12.9%), of whom 10 were male and 3 were female. Their median BMI was 22.7 kg/m2 (range, 17.9–26.4 kg/m2). Among the pre- and intraoperative factors, AL was significantly associated with tumor location (lower rectum), distance from the anal verge (< 6 cm), intraoperative blood loss (≥ 50 ml), and the number of linear staples (≥ 2) in univariate analysis. In multivariate analysis, only intraoperative blood loss (≥ 50 ml, odds ratio [OR] 4.59; 95% confidence interval [CI] 1.04–19.52; p = 0.045) was identified as an independent risk factor for AL. Among the postoperative factors, AL was significantly associated with tachycardia-POD1 (≥ 100 bpm), CRP-POD3 (≥ 15 mg/dl), fever on postoperative day (fever-POD) 3 (≥ 38 °C), and first defecation day after surgery (< POD3) in univariate analysis. In multivariate analysis, fever-POD3 (≥ 38 °C, OR 30.97; 95% CI 4.68–311.22; p = 0.0003) and first defecation day after surgery (< POD3, OR 5.82; 95% CI 1.34–31.30; p = 0.019) were identified as early predictive factors for AL. Conclusion In this study, intraoperative blood loss was an indicator of difficulty in a transection and anastomosing procedure, and fever-POD3 and early first defecation day after surgery were independent early predictive factors for AL. Careful surgery using an appropriate technique and standardized procedures with minimal bleeding and careful postoperative management paying attention to fever and defecation may prevent the onset and severity of AL.http://link.springer.com/article/10.1186/s12957-019-1716-3Rectal cancerAnastomotic leakageDouble-stapling techniqueLaparoscopic low anterior resection |
| spellingShingle | Masahiro Fukada Nobuhisa Matsuhashi Takao Takahashi Hisashi Imai Yoshihiro Tanaka Kazuya Yamaguchi Kazuhiro Yoshida Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer World Journal of Surgical Oncology Rectal cancer Anastomotic leakage Double-stapling technique Laparoscopic low anterior resection |
| title | Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer |
| title_full | Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer |
| title_fullStr | Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer |
| title_full_unstemmed | Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer |
| title_short | Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer |
| title_sort | risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer |
| topic | Rectal cancer Anastomotic leakage Double-stapling technique Laparoscopic low anterior resection |
| url | http://link.springer.com/article/10.1186/s12957-019-1716-3 |
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