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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2011

01-10-2011 | Colorectal Cancer

Risk Factors for Anastomotic Leakage after Rectal Cancer Resection and Reconstruction with Colorectostomy. A Retrospective Study with Bootstrap Analysis

Authors: Rene Warschkow, MD, Thomas Steffen, MD, Jutta Thierbach, MD, Thomas Bruckner, PhD, Jochen Lange, MD, Ignazio Tarantino, MD

Published in: Annals of Surgical Oncology | Issue 10/2011

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Abstract

Background

This study was designed to apply modern statistical methods to evaluate risk factors for anastomotic leakage after rectal cancer resection in a retrospective cohort of patients who received a colorectostomy. Whereas a diverting stoma and tumor height are considered proven risk factors for anastomotic leakage, a lack of evidence about additional risk factors persists.

Methods

In a single-center study, 527 consecutive patients who received a colorectostomy after rectal cancer resection between 1991 and 2008 were retrospectively assessed. In addition to traditional uni- and multivariate regression, locally weighted scatterplot smoothing (LOWESS) regression and bootstrap analysis were applied to increase internal validity.

Results

Anastomotic leakage occurred in 70 patients (13.3%; 95% confidence interval (CI), 10.5–16.5%) and mortality was 2.5% (95% CI, 1.4–4.2%). Diverting stoma (odds ratio (OR), 0.4; 95% CI, 0.17–0.61) and tumor height (OR, 0.88; 95% CI, 0.8–0.94) were proven to be protective. Neoadjuvant radiotherapy (OR, 2.15; 95% CI, 1.58–4.24) and intraoperative blood loss (OR, 1.05; 95% CI, 1.02–1.09) had a derogatory effect. Bootstrap analysis identified pre-existing vascular disease (95.5%), more advanced UICC stage III or IV tumors (95.7% or 91.5%, respectively), and intraoperative (96.1%) and postoperative (99.4%) blood substitution as harmful. Both intraoperative and postoperative blood substitution caused a dose-dependent increase in risk.

Conclusions

Applying statistical resampling methods identified intraoperative blood loss, blood substitution, vascular disease, and advanced UICC stage as risk factors for anastomotic leakage. Greater distances between the tumor and the anal verge and performance of a diverting stoma were associated with a decreased risk of anastomotic leakage.
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Metadata
Title
Risk Factors for Anastomotic Leakage after Rectal Cancer Resection and Reconstruction with Colorectostomy. A Retrospective Study with Bootstrap Analysis
Authors
Rene Warschkow, MD
Thomas Steffen, MD
Jutta Thierbach, MD
Thomas Bruckner, PhD
Jochen Lange, MD
Ignazio Tarantino, MD
Publication date
01-10-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 10/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1696-1

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