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Open Access 01-10-2014

Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis

Authors: Kenji Kawada, Suguru Hasegawa, Koya Hida, Kenjiro Hirai, Kae Okoshi, Akinari Nomura, Junichiro Kawamura, Satoshi Nagayama, Yoshiharu Sakai

Published in: Surgical Endoscopy | Issue 10/2014

Abstract

Background

Laparoscopic rectal surgery involving rectal transection and anastomosis with stapling devices is technically difficult. The aim of this study was to evaluate the risk factors for anastomotic leakage (AL) after laparoscopic low anterior resection (LAR) with double-stapling technique (DST) anastomosis.

Methods

This was a retrospective single-institution study of 154 rectal cancer patients who underwent laparoscopic LAR with DST anastomosis between June 2005 and August 2013. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses. The outcome of interest was clinical AL.

Results

The overall AL rate was 12.3 % (19/154). In univariate analysis, tumor size (P = 0.001), operative time (P = 0.049), intraoperative bleeding (P = 0.037), lateral lymph node dissection (P = 0.009), multiple firings of the linear stapler (P = 0.041), and precompression before stapler firings (P = 0.008) were significantly associated with AL. Multivariate analysis identified tumor size (odds ratio [OR] 4.01; 95 % confidence interval [CI] 1.25–12.89; P = 0.02) and precompression before stapler firings (OR 4.58; CI 1.22–17.20; P = 0.024) as independent risk factors for AL. In particular, precompression before stapler firing tended to reduce the AL occurring in early postoperative period.

Conclusions

Using appropriate techniques, laparoscopic LAR with DST anastomosis can be performed safely without increasing the risk of AL. Important risk factors for AL were tumor size and precompression before stapler firings.

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Title: Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis
Authors: Kenji Kawada
Suguru Hasegawa
Koya Hida
Kenjiro Hirai
Kae Okoshi
Akinari Nomura
Junichiro Kawamura
Satoshi Nagayama
Yoshiharu Sakai
Publication date: 01-10-2014
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2014
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-014-3564-0

At a glance: The STEP trials

Springer Medicine

Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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