| Xiaolong Chen,Libo Feng,Yu Liu,Dong Xia. Risk factors for anastomotic leakage after low anterior resection without diversional stomas. Oncol Transl Med, 2018, 4: 101-107. |
| Risk factors for anastomotic leakage after low anterior resection without diversional stomas |
| Received:February 02, 2018 Revised:July 14, 2018 |
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| KeyWord:anastomotic leakage (AL); low anterior resection (LAR); diversional stomas |
| Author Name | Affiliation | E-mail | | Xiaolong Chen | The Affiliated Hospital of Southwest Medical University | 1870747218@qq.com | | Libo Feng | The Affiliated Hospital of Southwest Medical University | | | Yu Liu | The Affiliated Hospital of Southwest Medical University | | | Dong Xia | The Affiliated Hospital of Southwest Medical University | juliahhy@aliyun.com |
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| Abstract: |
| Objective The most important complication after low anterior resection (LAR) for mid-low rectal cancer is
symptomatic anastomotic leakage (AL). More than one-third of patients with rectal cancer who underwent
LAR will have functional stomas during primary operation. The aim of this retrospective study was to
evaluate the risk factors associated with clinical AL following LAR without diversional stomas.
Methods Between 2012 and 2017, information about 578 consecutive patients with rectal tumors less
than 12 cm from the anal verge who underwent LAR without diversional stomas by the same surgical
team was collected retrospectively. A standardized extraperitonealized anastomosis and pelvic drainage
were conducted for all patients during primary operations, and the outcome of interest was clinical AL. The
associations between AL and 14 patient-related and surgical variables were examined by both univariate
chi-square test and multivariate logistic regression analysis.
Results The AL rate was 7.27% (42 of 578). Univariate and multivariate analyses showed that male
sex (P = 0.018), mid-low rectal cancer (located 10 cm or less above the anal verge) (P = 0.041), presence
of diabetes (odds ratio = 2.117), longer duration of operation (odds ratio = 1.890), and intraoperative
contamination (odds ratio = 2.163) were risk factors of AL for LAR without diversional stoma and
independently predictive of clinical AL. Nearly 83.3% (35 of 42) of leakage could be cured by persistent pelvic
irrigation-suction-drainage without surgical intervention. Only 7 patients (16.7%) with severe complications,
such as peritonitis, and fistula, required reoperation, and functional stoma was used as a salvage treatment.
Conclusion From the findings of this retrospective survey, we identified that mid-low rectal cancer and
male sex were independent risk factors for developing clinical AL after LAR without diversional stomas,
as well as longer duration of operation, presence of diabetes, and contamination of the operative field.
Moreover, we deemed that LAR without diversional stomas for mid-low rectal cancers was safe, effective,
and feasible. Extraperitonealized anastomosis and pelvic drainage obtained a relatively low rate of AL and
avoided unnecessary functional stomas. Pelvic irrigation-suction-drainage was an effective procedure to
resolve AL, and functional stoma was potentially used as a salvage modality for serious leakage. |
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