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World Journal of Surgery

Published in:

01-05-2010

Risk Factors for Symptomatic Anastomotic Leakage After Low Anterior Resection for Rectal Cancer with 30 Gy/10 f/2 w Preoperative Radiotherapy

Authors: Lin Wang, Jin Gu

Published in: World Journal of Surgery | Issue 5/2010

Abstract

Objective

This retrospective study was designed to analyze the risk factors for symptomatic leakage after low anterior resection (LAR) for patients with rectal cancer who received 30 Gy/10 f/2 w preoperative radiotherapy.

Methods

From April 2002 to December 2008, a total of 223 patients with mid-low rectal cancer received 30 Gy/10 f/2 w preoperative radiotherapy and underwent LAR. Six patients were excluded for positive air test, incomplete anastomotic rings, or other major adverse intraoperative events. In the 217 patients with satisfactory anastomoses, 15 probably factors relating to anastomotic leakage were recorded and statistically analyzed.

Results

The median patient age was 57 years, and 48% were women. The median level of anastomosis was 6 cm, median operating time was 130 minutes, and intraoperative blood loss was 200 ml. The symptomatic leakage rate was 11.5% (25/217). Multivariable analysis demonstrated that male gender (odds ratio (OR) = 2.63; p = 0.0474), level of anastomosis ≤4 cm (OR = 8.80; p = 0.038), no defunctioning stoma (OR = 3.80; p = 0.038), and blood loss >200 ml (OR = 3.32; p = 0.080) were the independent risk factors for anastomotic leakage.

Conclusions

For patients with rectal cancer treated with preoperative radiotherapy and low anterior resection, the risk factors for anastomotic leakage are male gender, lack of defunctioning stoma, level of anastomosis ≤4 cm, and blood loss >200 ml. A defunctioning stoma can decrease the occurrence of symptomatic anastomotic leakage and should be routinely performed in all low anterior resections after 30 Gy/10 f/2 w preoperative radiotherapy.

Matthiessen P, Hallböök O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6(6):462–469CrossRefPubMed

Hallbook O, Sjodahl R (1999) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83:60–62CrossRef

Bell SW, Walker KG, Rickard MJ et al (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266CrossRefPubMed

Walker KG, Bell SW, Rickard MJ et al (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240(2):255–259CrossRefPubMed

Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69(10):613–616CrossRefPubMed

Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet i:1479–1482CrossRef

Enker WE, Thaler HT, Cranor ML et al (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181:335–346PubMed

Martling A, Holm T, Johansson H et al (2001) The Stockholm II trial on preoperative radiotherapy in rectal carcinoma: long-term follow-up of a population-based study. Cancer 92(4):896–902CrossRefPubMed

Hansen MH, Kjaeve J, Revhaug A et al (2007) Impact of radiotherapy on local recurrence of rectal cancer in Norway. Br J Surg 94(1):113–118CrossRefPubMed

10.

Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646CrossRefPubMed

11.

Eriksen MT, Wibe A, Norstein J et al (2005) Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 7(1):51–57CrossRefPubMed

12.

Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240(2):260–268CrossRefPubMed

13.

Buie WD, MacLean AR, Attard JA et al (2005) Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer. Dis Colon Rectum 48(10):1868–1874CrossRefPubMed

14.

Bruce J, Krukowski ZH, Al-Khairy G et al (2001) Systematic review of the definition and measurement of anastomotic leakage after gastrointestinal surgery. Br J Surg 88(9):1157–1168CrossRefPubMed

15.

Rullier E, Laurent C, Garrelon JL et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85(3):355–358CrossRefPubMed

16.

Enker WE, Merchant N, Cohen AM et al (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230(4):544–552; discussion 552–554CrossRefPubMed

17.

Kapiteijn E, Kranenbarg EK, Steup WH et al (1999) Total mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer. Prospective randomised trial with standard operative and histopathological techniques. Dutch ColoRectal Cancer Group. Eur J Surg 165(5):410–420

18.

Law WL, Chu KW, Ho JW et al (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179(2):92–96CrossRefPubMed

19.

Peeters KC, Tollenaar RA, Marijnen CA et al (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92(2):211–216CrossRefPubMed

20.

Yeh CY, Changchien CR, Wang JY et al (2005) Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 241(1):9–13PubMed

21.

Gastinger I, Marusch F, Steinert R et al (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92(9):1137–1142CrossRefPubMed

22.

Sauer R, Fietkau R, Wittekind C et al (2003) Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis 5(5):406–415CrossRefPubMed

23.

Read TE, Ogunbiyi OA, Fleshman JW et al (2001) Neoadjuvant external beam radiation and proctectomy for adenocarcinoma of the rectum. Dis Colon Rectum 44(12):1778–1790CrossRefPubMed

24.

Widder J, Herbst F, Dobrowsky W et al (2005) Preoperative short-term radiation therapy (25 Gy, 2.5 Gy twice daily) for primary resectable rectal cancer (phase II). Br J Cancer 92(7):1209–1214CrossRefPubMed

25.

Lyall A, McAdam TK, Townend J et al (2007) Factors affecting anastomotic complications following anterior resection in rectal cancer. Colorectal Dis 9(9):801–807CrossRefPubMed

26.

Luna-Perez P, Rodriguez-Ramirez SE, Gutierrez de la Barrera M et al (2002) Multivariate analysis of risk factors associated with dehiscence of colorectal anastomosis after anterior or lower anterior resection for sigmoid or rectal cancer. Rev Invest Clin 54(6):501–508PubMed

27.

Lipska MA, Bissett IP, Parry BR et al (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76(7):579–585CrossRefPubMed

28.

Jung SH, Yu CS, Choi PW et al (2008) Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum 51(6):902–908CrossRefPubMed

29.

Kruschewski M, Rieger H, Pohlen U et al (2007) Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22(8):919–927CrossRefPubMed

30.

Marusch F, Koch A, Schmidt U et al (2002) Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation. Langenbecks Arch Surg 387(2):94–100CrossRefPubMed

31.

Konishi T, Watanabe T, Kishimoto J et al (2006) Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 202(3):439–444CrossRefPubMed

32.

Eberl T, Jagoditsch M, Klingler A et al (2008) Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg 196(4):592–598CrossRefPubMed

33.

Nesbakken A, Nygaard K, Westerheim O et al (2002) Audit of intraoperative and early postoperative complications after introduction of mesorectal excision for rectal cancer. Eur J Surg 168(4):229–235CrossRefPubMed

34.

Hilsabeck JR (1982) The presacral space as a collector of fluid accumulations following rectal anastomosis: tolerance of rectal anastomosis to closed suction pelvic drainage. Dis Colon Rectum 25:680–684CrossRefPubMed

35.

Marijnen CA, Kapiteijn E, van de Velde CJ et al (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20(3):817–825CrossRefPubMed

36.

O’Leary DP, Fide CJ, Foy C et al (2001) Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg 88:1216–1220CrossRefPubMed

37.

Bailey CM, Wheeler JM, Birks M, Farouk R (2003) The incidence and causes of permanent stoma after anterior resection. Colorectal Dis 5:331–334CrossRefPubMed

38.

Karanjia ND, Corder AP, Bearn P et al (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226CrossRefPubMed

39.

Alberts JCJ, Parvaiz A, Moran BJ (2003) Predicting the risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis 5:478–482CrossRefPubMed

40.

Marusch F, Koch A, Schmidt U et al (2002) Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 45(9):1164–1171CrossRefPubMed

41.

Pakkastie TE, Ovaska JT, Pekkala ES et al (1997) A randomized study of colostomies in low colorectal anastomoses. Eur J Surg 163:929–933PubMed

42.

Matthiessen P, Hallböök O, Rutegård J et al (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246(2):207–214CrossRefPubMed

43.

Ulrich AB, Seiler C, Rahbari N et al (2009) Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum 52(3):412–418PubMed

44.

Hüser N, Michalski CW, Erkan M et al (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248(1):52–60CrossRefPubMed

45.

Tan WS, Tang CL, Shi L et al (2009) Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 96(5):462–472CrossRefPubMed

46.

Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–820CrossRefPubMed

Title: Risk Factors for Symptomatic Anastomotic Leakage After Low Anterior Resection for Rectal Cancer with 30 Gy/10 f/2 w Preoperative Radiotherapy
Authors: Lin Wang
Jin Gu
Publication date: 01-05-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 5/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0449-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk Factors for Symptomatic Anastomotic Leakage After Low Anterior Resection for Rectal Cancer with 30 Gy/10 f/2 w Preoperative Radiotherapy

Abstract

Objective

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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