Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision

The Korean laparoscopic colorectal surgery study group

Jun Seok Park, Gyu Seog Choi, Seon Hahn Kim, Hyeong Rok Kim, Namkyu Kim, Kang Young Lee, Sung Bum Kang, Ji Yeon Kim, Kil Yeon Lee, Byung Chun Kim, Byung Noe Bae, Gyung Mo Son, Sun Il Lee, Hyun Kang

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

OBJECTIVE: To assess the risk factors for clinical anastomotic leakage (AL) in patients undergoing laparoscopic surgery for rectal cancer. BACKGROUND: Little data are available about risk factors for AL after laparoscopic rectal cancer resection. METHODS: This was a retrospective analysis of 1609 patients with rectal cancer who had undergone laparoscopic surgery for rectal cancer with sphincter preservation. Clinical data related to AL were collected from 11 institutions. Univariate and multivariate analyses were performed to determine the risk factors for AL. RESULTS: AL was noted in 101 (6.3%) of the patients. The leakage rate ranged from 2.0% to 10.3% for each hospital (P = 0.04). In patients without protective stomas (n = 1187), male sex [hazard ratio (HR), 3.468], advanced tumor stage (HR, 2.520), lower tumor level (HR, 2.418), preoperative chemoradiation (HR, 6.284), perioperative transfusion (HR, 10.705), and multiple firings of the linear stapler (HR, 6.181) were significantly associated with AL. Our theoretical model suggested that the HR for patients with 2 risk factors was significantly higher than that the HR for patients with no or only 1 risk factor. CONCLUSIONS: Male sex, low anastomosis, preoperative chemoradiation, advanced tumor stage, perioperative bleeding, and multiple firings of the linear stapler increased the risk of AL after laparoscopic surgery for rectal cancer. A diverting stoma might be mandatory in patients with 2 or more of the risk factors identified in this analysis.

Original languageEnglish
Pages (from-to)665-671
Number of pages7
JournalAnnals of surgery
Volume257
Issue number4
DOIs
Publication statusPublished - 2013 Apr 1

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Colorectal Surgery
Anastomotic Leak
Rectal Neoplasms
Laparoscopy
Neoplasms
Sex Ratio
Theoretical Models
Multivariate Analysis
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Park, Jun Seok ; Choi, Gyu Seog ; Kim, Seon Hahn ; Kim, Hyeong Rok ; Kim, Namkyu ; Lee, Kang Young ; Kang, Sung Bum ; Kim, Ji Yeon ; Lee, Kil Yeon ; Kim, Byung Chun ; Bae, Byung Noe ; Son, Gyung Mo ; Lee, Sun Il ; Kang, Hyun. / Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision : The Korean laparoscopic colorectal surgery study group. In: Annals of surgery. 2013 ; Vol. 257, No. 4. pp. 665-671.
@article{a1398dce2c97413291edf2578379424a,
title = "Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: The Korean laparoscopic colorectal surgery study group",
abstract = "OBJECTIVE: To assess the risk factors for clinical anastomotic leakage (AL) in patients undergoing laparoscopic surgery for rectal cancer. BACKGROUND: Little data are available about risk factors for AL after laparoscopic rectal cancer resection. METHODS: This was a retrospective analysis of 1609 patients with rectal cancer who had undergone laparoscopic surgery for rectal cancer with sphincter preservation. Clinical data related to AL were collected from 11 institutions. Univariate and multivariate analyses were performed to determine the risk factors for AL. RESULTS: AL was noted in 101 (6.3{\%}) of the patients. The leakage rate ranged from 2.0{\%} to 10.3{\%} for each hospital (P = 0.04). In patients without protective stomas (n = 1187), male sex [hazard ratio (HR), 3.468], advanced tumor stage (HR, 2.520), lower tumor level (HR, 2.418), preoperative chemoradiation (HR, 6.284), perioperative transfusion (HR, 10.705), and multiple firings of the linear stapler (HR, 6.181) were significantly associated with AL. Our theoretical model suggested that the HR for patients with 2 risk factors was significantly higher than that the HR for patients with no or only 1 risk factor. CONCLUSIONS: Male sex, low anastomosis, preoperative chemoradiation, advanced tumor stage, perioperative bleeding, and multiple firings of the linear stapler increased the risk of AL after laparoscopic surgery for rectal cancer. A diverting stoma might be mandatory in patients with 2 or more of the risk factors identified in this analysis.",
author = "Park, {Jun Seok} and Choi, {Gyu Seog} and Kim, {Seon Hahn} and Kim, {Hyeong Rok} and Namkyu Kim and Lee, {Kang Young} and Kang, {Sung Bum} and Kim, {Ji Yeon} and Lee, {Kil Yeon} and Kim, {Byung Chun} and Bae, {Byung Noe} and Son, {Gyung Mo} and Lee, {Sun Il} and Hyun Kang",
year = "2013",
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doi = "10.1097/SLA.0b013e31827b8ed9",
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Park, JS, Choi, GS, Kim, SH, Kim, HR, Kim, N, Lee, KY, Kang, SB, Kim, JY, Lee, KY, Kim, BC, Bae, BN, Son, GM, Lee, SI & Kang, H 2013, 'Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: The Korean laparoscopic colorectal surgery study group', Annals of surgery, vol. 257, no. 4, pp. 665-671. https://doi.org/10.1097/SLA.0b013e31827b8ed9

Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision : The Korean laparoscopic colorectal surgery study group. / Park, Jun Seok; Choi, Gyu Seog; Kim, Seon Hahn; Kim, Hyeong Rok; Kim, Namkyu; Lee, Kang Young; Kang, Sung Bum; Kim, Ji Yeon; Lee, Kil Yeon; Kim, Byung Chun; Bae, Byung Noe; Son, Gyung Mo; Lee, Sun Il; Kang, Hyun.

In: Annals of surgery, Vol. 257, No. 4, 01.04.2013, p. 665-671.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision

T2 - The Korean laparoscopic colorectal surgery study group

AU - Park, Jun Seok

AU - Choi, Gyu Seog

AU - Kim, Seon Hahn

AU - Kim, Hyeong Rok

AU - Kim, Namkyu

AU - Lee, Kang Young

AU - Kang, Sung Bum

AU - Kim, Ji Yeon

AU - Lee, Kil Yeon

AU - Kim, Byung Chun

AU - Bae, Byung Noe

AU - Son, Gyung Mo

AU - Lee, Sun Il

AU - Kang, Hyun

PY - 2013/4/1

Y1 - 2013/4/1

N2 - OBJECTIVE: To assess the risk factors for clinical anastomotic leakage (AL) in patients undergoing laparoscopic surgery for rectal cancer. BACKGROUND: Little data are available about risk factors for AL after laparoscopic rectal cancer resection. METHODS: This was a retrospective analysis of 1609 patients with rectal cancer who had undergone laparoscopic surgery for rectal cancer with sphincter preservation. Clinical data related to AL were collected from 11 institutions. Univariate and multivariate analyses were performed to determine the risk factors for AL. RESULTS: AL was noted in 101 (6.3%) of the patients. The leakage rate ranged from 2.0% to 10.3% for each hospital (P = 0.04). In patients without protective stomas (n = 1187), male sex [hazard ratio (HR), 3.468], advanced tumor stage (HR, 2.520), lower tumor level (HR, 2.418), preoperative chemoradiation (HR, 6.284), perioperative transfusion (HR, 10.705), and multiple firings of the linear stapler (HR, 6.181) were significantly associated with AL. Our theoretical model suggested that the HR for patients with 2 risk factors was significantly higher than that the HR for patients with no or only 1 risk factor. CONCLUSIONS: Male sex, low anastomosis, preoperative chemoradiation, advanced tumor stage, perioperative bleeding, and multiple firings of the linear stapler increased the risk of AL after laparoscopic surgery for rectal cancer. A diverting stoma might be mandatory in patients with 2 or more of the risk factors identified in this analysis.

AB - OBJECTIVE: To assess the risk factors for clinical anastomotic leakage (AL) in patients undergoing laparoscopic surgery for rectal cancer. BACKGROUND: Little data are available about risk factors for AL after laparoscopic rectal cancer resection. METHODS: This was a retrospective analysis of 1609 patients with rectal cancer who had undergone laparoscopic surgery for rectal cancer with sphincter preservation. Clinical data related to AL were collected from 11 institutions. Univariate and multivariate analyses were performed to determine the risk factors for AL. RESULTS: AL was noted in 101 (6.3%) of the patients. The leakage rate ranged from 2.0% to 10.3% for each hospital (P = 0.04). In patients without protective stomas (n = 1187), male sex [hazard ratio (HR), 3.468], advanced tumor stage (HR, 2.520), lower tumor level (HR, 2.418), preoperative chemoradiation (HR, 6.284), perioperative transfusion (HR, 10.705), and multiple firings of the linear stapler (HR, 6.181) were significantly associated with AL. Our theoretical model suggested that the HR for patients with 2 risk factors was significantly higher than that the HR for patients with no or only 1 risk factor. CONCLUSIONS: Male sex, low anastomosis, preoperative chemoradiation, advanced tumor stage, perioperative bleeding, and multiple firings of the linear stapler increased the risk of AL after laparoscopic surgery for rectal cancer. A diverting stoma might be mandatory in patients with 2 or more of the risk factors identified in this analysis.

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U2 - 10.1097/SLA.0b013e31827b8ed9

DO - 10.1097/SLA.0b013e31827b8ed9

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SP - 665

EP - 671

JO - Annals of Surgery

JF - Annals of Surgery

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