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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2016

01-02-2016 | Colorectal Cancer

Risk Factors for Anastomotic Leakage After Intersphincteric Resection Without a Protective Defunctioning Stoma for Lower Rectal Cancer

Authors: Motoi Koyama, MD, Akihiko Murata, MD, Yoshiyuki Sakamoto, MD, Hajime Morohashi, MD, Tatsuya Hasebe, MD, Takeshi Saito, MD, Kenichi Hakamada, MD

Published in: Annals of Surgical Oncology | Special Issue 2/2016

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Abstract

Background

Intersphincteric resection (ISR) is performed as an alternative to abdominoperineal resection for super-low rectal cancer. The purpose of this study was to evaluate risk factors for anastomotic leakage (AL) after ISR without a defunctioning stoma for lower rectal cancer.

Methods

Between 1995 and 2012, 135 consecutive patients with lower rectal cancer underwent curative ISR without a protective defunctioning stoma. Univariate and multivariate analyses were performed to determine the risk factors for AL.

Results

The radiological and symptomatic AL rate was 17.0 % (23/135). Univariate analysis demonstrated that male sex (P = 0.030), preoperative chemotherapy (P = 0.016), partial ISR (P < 0.001), lateral lymph-node dissection (P = 0.042), distal tumor distance from the dentate line (P = 0.007), and straight reconstruction (P < 0.001) were significantly associated with AL. Severe AL requiring re-laparotomy developed in 13 (9.6 %) patients. Univariate analysis demonstrated that male sex (P = 0.006), partial ISR (P < 0.001), distal tumor distance from the dentate line (P = 0.002), and straight reconstruction (P < 0.001) were significantly associated with AL requiring relaparotomy. Multivariate analysis demonstrated that partial ISR [odds ratio (OR) 6.701; P = 0.001] and straight reconstruction (OR 5.552; P = 0.002) were independently predictive of AL.

Conclusions

Partial ISR and straight reconstruction increased the risk of AL after ISR without a protective defunctioning stoma. A defunctioning stoma might be mandatory in patients with the risk factors identified in this analysis.
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Metadata
Title
Risk Factors for Anastomotic Leakage After Intersphincteric Resection Without a Protective Defunctioning Stoma for Lower Rectal Cancer
Authors
Motoi Koyama, MD
Akihiko Murata, MD
Yoshiyuki Sakamoto, MD
Hajime Morohashi, MD
Tatsuya Hasebe, MD
Takeshi Saito, MD
Kenichi Hakamada, MD
Publication date
01-02-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue Special Issue 2/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4461-z

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