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Lv Q, Shu XP, Peng D, Li SQ, Xiang Z. Predictors of complications after prophylactic ileostomy reversal for rectal cancer: A retrospective study. World J Gastrointest Surg 2024; 16:1354-1362. [PMID: 38817282 PMCID: PMC11135311 DOI: 10.4240/wjgs.v16.i5.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer (RC), but there were significant differences in the reported risk factors for complications after stoma reversal. No studies have analyzed the risk factors for stoma-related complications and overall postoperative complications separately. AIM To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC. METHODS This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022. Continuous variables are expressed as the mean ± SD and were analyzed with independent-sample t tests, while frequency variables are expressed as n (%), and the χ2 test or Fisher's exact test was used. Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications. RESULTS The overall complication rate after ileostomy reversal was 11.4%. Patients with lower preoperative albumin concentration (P < 0.01), greater blood loss (P = 0.017), and longer operative times (P < 0.01) were more likely to experience postoperative complications. The incidence of stoma-related complications was 6.4%. Analysis of the study showed that a higher body mass index (BMI) (P < 0.01), preoperative comorbid hypertension (P = 0.049), time from primary surgery to ileostomy reversal (P < 0.01) and longer operation time (P = 0.010) were more likely to result in stoma-related complications postoperatively. Multivariate logistic regression analysis revealed that a lower preoperative albumin level (P < 0.01, OR = 0.888, 95%CI: 0.828-0.958) was an independent risk factor for overall complications. Moreover, multivariate analysis revealed that BMI (P < 0.01, OR = 1.176, 95%CI: 1.041-1.330) and time from primary surgery to ileostomy reversal (P < 0.01, OR = 1.140, 95%CI: 1.038-1.252) were independent risk factors for stoma-related complications after stoma reversal. CONCLUSION The preoperative albumin level was a predictor of overall complications. Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.
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Affiliation(s)
- Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin-Peng Shu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Si-Qi Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zheng Xiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Li HY, Zhou JT, Wang YN, Zhang N, Wu SF. Establishment and application of three predictive models of anastomotic leakage after rectal cancer sphincter-preserving surgery. World J Gastrointest Surg 2023; 15:2201-2210. [PMID: 37969722 PMCID: PMC10642475 DOI: 10.4240/wjgs.v15.i10.2201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Anastomotic leakage (AL) occurs frequently after sphincter-preserving surgery for rectal cancer and has a significant mortality rate. There are many factors that influence the incidence of AL, and each patient's unique circumstances add to this diversity. The early identification and prediction of AL after sphincter-preserving surgery are of great significance for the application of clinically targeted preventive measures. Developing an AL predictive model coincides with the aim of personalised healthcare, enhances clinical management techniques, and advances the medical industry along a more precise and intelligent path. AIM To develop nomogram, decision tree, and random forest prediction models for AL following sphincter-preserving surgery for rectal cancer and to evaluate the predictive efficacy of the three models. METHODS The clinical information of 497 patients with rectal cancer who underwent sphincter-preserving surgery at Jincheng People's Hospital of Shanxi Province between January 2017 and September 2022 was analyzed in this study. Patients were divided into two groups: AL and no AL. Using univariate and multivariate analyses, we identified factors influencing postoperative AL. These factors were used to establish nomogram, decision tree, and random forest models. The sensitivity, specificity, recall, accuracy, and area under the receiver operating characteristic curve (AUC) were compared between the three models. RESULTS AL occurred in 10.26% of the 497 patients with rectal cancer. The nomogram model had an AUC of 0.922, sensitivity of 0.745, specificity of 0.966, accuracy of 0.936, recall of 0.987, and accuracy of 0.946. The above indices in the decision tree model were 0.919, 0.833, 0.862, 0.951, 0.994, and 0.955, respectively and in the random forest model were 1.000, 1.000, 1.000, 0.951, 0.994, and 0.955, respectively. The DeLong test revealed that the AUC value of the decision-tree model was lower than that of the random forest model (P < 0.05). CONCLUSION The random forest model may be used to identify patients at high risk of AL after sphincter-preserving surgery for rectal cancer owing to its strong predictive effect and stability.
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Affiliation(s)
- Hui-Yuan Li
- Department of General Surgery, Jincheng People’s Hospital of Shanxi Province, Jincheng 048026, Shanxi Province, China
| | - Jiang-Tao Zhou
- Department of General Surgery, Jincheng People’s Hospital of Shanxi Province, Jincheng 048026, Shanxi Province, China
| | - Ya-Nan Wang
- Department of General Surgery, Jincheng People’s Hospital of Shanxi Province, Jincheng 048026, Shanxi Province, China
| | - Ning Zhang
- Department of General Surgery, Jincheng People’s Hospital of Shanxi Province, Jincheng 048026, Shanxi Province, China
| | - Shao-Fen Wu
- Department of Gastroenterology, Jincheng People’s Hospital of Shanxi Province, Jincheng 048026, Shanxi Province, China
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Surgical management and outcomes of obstructive colorectal cancer in elderly patients: A multi-institutional retrospective study. Surgery 2022; 172:60-68. [PMID: 34998620 DOI: 10.1016/j.surg.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The outcomes and prognostic factors of elderly patients with obstructive colorectal cancer are unknown. This was the focus of our multi-institutional retrospective study. METHODS Medical records of 520 patients (elderly [group E, aged ≥75 years, n = 271]; and nonelderly [group NE, aged <75 years, n = 249]) who received treatment for obstructive colorectal cancer in 2008 to 2018 at 14 leading hospitals in Kagawa prefecture (Japan) were reviewed. Short- and long-term outcomes of patients who underwent tumor resection (n = 438) were compared between the groups. Their prognostic factors were identified. RESULTS The tumor resection rate was 79% (n = 213) and 90% (n = 225) in groups E and NE, respectively. Group E had more emergency resections (27 [12.7%] vs 15 [6.6%], P = .037), shorter operating times (194 vs 221 min, P < .001), fewer dissected lymph nodes (14 vs 17, P = .004), and less adjuvant chemotherapy (47 [26.8%] vs 122 [76.7%], p < .001) than group NE. Postoperative complication rates and recurrence-free survival were not significantly different between the groups. Overall survival was significantly lower in group E than in group NE. Distant metastases and no postoperative chemotherapy were independent poor prognostic factors for overall survival in groups E and NE. Emergency resection (hazard ratio:1.83; 95% confidence interval: 1.02-3.26) was a significant poor prognostic indicator in group E only. CONCLUSIONS The short-term outcomes and recurrence-free survival of elderly and nonelderly patients with obstructive colorectal cancer were similar, although the 90-day mortality rate of the elderly patients was higher. Furthermore, elective surgery after bowel decompression is associated with a better outcome in the elderly.
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4
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Robotic and laparoscopic surgical procedures for colorectal cancer. J Robot Surg 2022; 17:375-381. [PMID: 35687279 DOI: 10.1007/s11701-022-01418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/23/2022] [Indexed: 10/18/2022]
Abstract
The study aims to investigate perioperative indices and immediate outcomes of laparoscopic and robotic surgical interventions in colorectal cancer patients. The study included 163 patients [90 (55.2%) females and 73 (44.8%) males, aged 67.46 ± 6.72 years, on average] who had surgery for morphologically checked colorectal cancer. Of those, 101 patients had laparoscopic surgery (Group 1), and 62 patients had robot-assisted surgery (Group 2). The study found that the safety profile of both robot and laparoscopic procedures for colorectal cancer is comparable. The total complication rate in the laparoscopic group was 6.9% (in 7 patients), in the robot-assisted group-11.3% (in 7 patients) (χ2 = 0.93, p = 0.34). Robotic surgery for colorectal cancer is a promising direction for improving patients' level and quality of care with this oncological pathology.
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Hashimoto S, Tominaga T, Nonaka T, To K, Wada H, Takeshita H, Fukuoka H, Araki M, Tanaka K, Sawai T, Nagayasu T. Short- and mid-term outcomes of laparoscopic colorectal surgery in patients ≥ 85 years old: a multicenter study using a propensity score-matched analysis. Surg Today 2022; 52:1292-1298. [DOI: 10.1007/s00595-022-02468-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
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Utsumi M, Matsuda T, Yamashita K, Hasegawa H, Agawa K, Urakawa N, Kanaji S, Oshikiri T, Nakamura T, Kakeji Y. Short-term and long-term outcomes after laparoscopic surgery for elderly patients with colorectal cancer aged over 80 years: a propensity score matching analysis. Int J Colorectal Dis 2021; 36:2519-2528. [PMID: 34254160 DOI: 10.1007/s00384-021-03973-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE There has been an increase in the percentage of elderly patients with colorectal cancer (CRC). However, few studies have reported the short- and long-term outcomes of laparoscopic surgery for elderly patients with CRC aged over 80 years. METHODS This study included 529 patients who underwent laparoscopic resection for clinical stage 0-III CRC at Kobe University Hospital between January 2010 and December 2018. Propensity score matching (PSM) was used to create balanced cohorts of the elderly (aged ≥ 80, n = 113) and the non-elderly (aged < 80, n = 113). Their clinical outcomes were compared after PSM. RESULTS After matching, carcinoembryonic antigen (CEA) level was higher in the non-elderly group, and adjuvant chemotherapy was less frequently employed in the elderly group. D3 dissection was performed more frequently and the number of the harvested lymph nodes tended to be larger in the non-elderly group. There was no significant difference in the rates of postoperative complications, reoperation within 30 days, and 30-day mortality between the groups. The 5-year relapse-free survival rate was not statistically different between the two groups (77.3% for the non-elderly vs. 62.7% for the elderly, p = 0.13). The multivariate analyses for the whole cohort showed that the factors of sex, tumor location, operation time, and conversion to open surgery, but not the age, were significant predictors of postoperative complications. CONCLUSION Laparoscopic surgery for colorectal cancer patients aged over 80 years is technically and oncologically safe.
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Affiliation(s)
- Masako Utsumi
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeru Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. .,Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan.
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kyosuke Agawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Urakawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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7
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Evaluation of short- and long-term outcomes following laparoscopic surgery for colorectal cancer in elderly patients aged over 80 years old: a propensity score-matched analysis. Int J Colorectal Dis 2021; 36:365-375. [PMID: 33026476 DOI: 10.1007/s00384-020-03770-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE It remains controversial whether the advantages of laparoscopic surgery for colorectal cancer (CRC) are beneficial in elderly patients (EP, age ≥ 80 years). The present study aimed to evaluate whether age itself is an independent risk factor for laparoscopic surgery by comparing short- and long-term outcomes between non-EP and EP groups. METHODS We retrospectively analyzed 730 consecutive patients with stage I-III CRC who had undergone elective surgery between 2010 and 2017, using propensity score-matched analysis. RESULTS Median follow-up was 49 months. After matching, we enrolled 228 patients. In the matched cohort, estimated operative time, estimated blood loss, lymph node dissection ≥ D3, number of lymph nodes harvested < 12, conversion rate, multivisceral resection rate, postoperative complication rate, and length of postsurgical stay were similar between the two groups. Before matching, compared with the non-EP group, the EP group had significantly shorter overall survival (OS) (p < 0.01), cancer-specific survival (CSS) (p < 0.01), recurrence-free survival (RFS) (p < 0.01), and higher frequency of local recurrence (LR) (p = 0.01); however, there was no significant difference in terms of incidence of LR or CSS between the two groups in the matched cohort. Prior to matching, multivariate analysis identified age ≥ 80 years as an independent prognostic factor for OS (p < 0.01), CSS (p < 0.01), and RFS (p = 0.01); however, after matching, age ≥ 80 years was not an independent poor prognostic factor for OS or CCS. CONCLUSIONS Laparoscopic surgery offers a safe, effective option for CRC in EP aged ≥ 80 years.
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Fukudome I, Maeda H, Okamoto K, Kuroiwa H, Yamaguchi S, Fujisawa K, Shiga M, Dabanaka K, Kobayashi M, Namikawa T, Hanazaki K. The safety of early versus late ileostomy reversal after low anterior rectal resection: a retrospective study in 47 patients. Patient Saf Surg 2021; 15:7. [PMID: 33423686 PMCID: PMC7798274 DOI: 10.1186/s13037-020-00275-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023] Open
Abstract
Background This study aimed to clarify the safety of early closure in diverting ileostomy with lower anterior rectal-cancer resection. Methods We retrospectively reviewed consecutive 47 patients who underwent diverting ileostomy with lower rectal-cancer resection between May 2009 and October 2017. The results of the stoma closure were compared between patients who underwent stoma closure within 90 days (early closure [EC] group) and those who underwent late closure (LC group; closure after 90 days). Because of the small sample size, the frequency of severe complications post closure was analyzed. Results Among 47 patients, 29 were in the EC group. Postoperative complications occurred in 48.3% (14/29) and 27.8% (5/18) of patients in the EC and LC groups, respectively. This difference was due to minor complications (Clavien-Dindo Classification I/II), such as superficial incisional surgical site infections (n=5) in the EC group. The rate of severe complications (Clavien-Dindo Classification ≥ III) was similar between the groups (20.7% vs. 16.7%, p=1, Fisher’s exact test). Conclusions No association was observed between the time of closure and development of major complications; however, there was an increased likelihood of minor complications after EC. This study provides a basis on which future treatment guidelines for early stoma closure may be developed without affecting patient quality of life.
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Affiliation(s)
- Ian Fukudome
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan.
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan
| | - Ken Okamoto
- Cancer Treatment Center, Kochi Medical School, Kohasu, Oko-cho, Nankoku-city, 783-8505, Kochi, Japan
| | - Hajime Kuroiwa
- Integrated Center for Advanced Medical Technologies (ICAM-Tech), Kochi Medical School, Nankoku-city, Japan
| | - Sachi Yamaguchi
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan
| | - Kazune Fujisawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan
| | - Mai Shiga
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan
| | - Ken Dabanaka
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School, Kohasu, Oko-cho, Nankoku-city, 783-8505, Kochi, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, 783-8505, Nankoku-city, Kochi, Japan
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Fujieda Y, Maeda H, Oba K, Okamoto K, Fukudome I, Shiga M, Kawanishi Y, Akimori T, Kuroiwa H, Nishimoto H, Namikawa T, Murakami I, Kobayashi M, Hanazaki K. Lymph node retrieval after colorectal cancer surgery: a comparative study of the efficacy between the conventional manual method and a new fat dissolution method. Surg Today 2020; 50:726-733. [PMID: 31912338 DOI: 10.1007/s00595-019-01944-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/05/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This study compared the efficacy of two different methods for lymph node (LN) searching after colorectal cancer surgery: the fat dissolution and the conventional manual method. METHODS For the fat dissolution method, we used a commercially available solution of collagenase and lipase (FD group). The primary endpoint was the number of identified LNs in the FD group compared to an historical control (control group) after adjusting by propensity score matching. RESULTS Using 37 matched patients from each group, we identified 20.6 ± 7.2 LNs using the fat dissolution method compared to 13.5 ± 5.9 using the conventional method (t test, P < 0.01). Three patients in the FD group received an inappropriate LN examination in terms of number, while the number of the retrieved LNs was < 12 in 12 patients in the control group. The mean diameter of LNs without metastasis was 3.2 ± 1.9 mm in the FD group, and 40% of metastasis cases were found in LNs < 5 mm in diameter. A pathological examination confirmed that using the fat resolution method did not change the morphological or immunochemical staining findings. CONCLUSION We demonstrated that fat dissolution had a positive impact on the number of retrieved LNs after colorectal cancer surgery without disturbing the microscopic observation.
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Affiliation(s)
- Yuki Fujieda
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.,Department of Surgery, Hata-Kenmin Hospital, Sukumo, Kochi, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Koji Oba
- Department of Biostatistics, Graduated School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken Okamoto
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.,Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Mai Shiga
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | | | - Toyokazu Akimori
- Department of Surgery, Hata-Kenmin Hospital, Sukumo, Kochi, Japan
| | - Hajime Kuroiwa
- Integrated Center for Advanced Medical Technologies (ICAM-Tech), Kochi Medical School, Nankoku, Kochi, Japan
| | - Hiroyuki Nishimoto
- Integrated Center for Advanced Medical Technologies (ICAM-Tech), Kochi Medical School, Nankoku, Kochi, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Ichiro Murakami
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Michiya Kobayashi
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.,Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Taguchi K, Shimomura M, Egi H, Hattori M, Mukai S, Kochi M, Sada H, Sumi Y, Nakashima I, Akabane S, Sato K, Ohdan H. Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications? Surg Today 2019; 49:948-957. [PMID: 31230127 PMCID: PMC6800856 DOI: 10.1007/s00595-019-01839-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE The number of patients on antiplatelet therapy (APT) who need surgery is increasing; however, it is unclear whether APT should be continued for abdominal surgery, particularly laparoscopic colorectal surgery. We investigated the safety of continuing APT for patients undergoing laparoscopic colorectal surgery. METHODS We collected retrospective data from 529 patients who underwent laparoscopic colorectal surgery at Hiroshima University between January, 2013 and December, 2018. We analyzed information related to APT. Thirty-six pairs were matched by the propensity score method between patients on APT (APT+) and those not on APT (APT-). We compared the surgical outcomes of both groups. RESULTS Among 463 patients eligible for the study, 48 were on APT for cerebrovascular or cardiovascular disease, and 36 continued to take aspirin. In the case-matched comparison, the amount of intraoperative blood loss in the APT+ group was not significantly higher than that in the APT- group, and the incidences of bleeding complications, thromboembolic complications, and other complications were not significantly different between the groups. CONCLUSION In a case-matched comparison, continuation of aspirin during laparoscopic colorectal surgery did not increase perioperative complications. In laparoscopic colorectal surgery, continuation of aspirin is an acceptable strategy for patients with thromboembolic risk caused by interruption of APT.
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Affiliation(s)
- Kazuhiro Taguchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan.,Institute for Clinical Research, National Hospital Organization, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyamacho, Kure, Hiroshima, 737-0023, Japan
| | - Manabu Shimomura
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan.
| | - Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Minoru Hattori
- Advanced Medical Skills Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shoichiro Mukai
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Masatoshi Kochi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Haruki Sada
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Yusuke Sumi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Ikki Nakashima
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shintaro Akabane
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Koki Sato
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Hiroshima, 734-8551, Japan
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11
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Numata M, Sawazaki S, Aoyama T, Tamagawa H, Sato T, Saeki H, Saigusa Y, Taguri M, Mushiake H, Oshima T, Yukawa N, Shiozawa M, Rino Y, Masuda M. D3 lymph node dissection reduces recurrence after primary resection for elderly patients with colon cancer. Int J Colorectal Dis 2019; 34:621-628. [PMID: 30659360 DOI: 10.1007/s00384-018-03233-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE The favorable oncological impact of D3 lymph node dissection after colon cancer surgery has been described previously. However, D3 lymph node dissection is potentially more invasive than conventional D2 lymph node dissection. The oncological merit of D3 lymph node dissection in elderly patients with colon cancer remains unclear. This study aimed to clarify the oncological outcome after D3 lymph node dissection in patients with colon cancer aged > 75 years. METHODS This is a retrospective cohort analysis using propensity matching method. The study was conducted at a university hospital and two community teaching hospitals in a large urban city. A total of 378 consecutive patients with pathological stage II and stage III colon cancer who underwent primary resection with either D2 or D3 lymph node dissection were retrospectively identified on a prospective database between 2000 and 2015. The primary and secondary outcomes of interests were recurrence-free survival and postoperative complication rate, respectively. RESULTS After propensity matching, 232 patients were analyzed. The long-term findings showed that the elderly who underwent D3 lymph node dissection had significantly better recurrence-free survival than those who underwent D2 lymph node dissection (p = 0.01). The incidence of postoperative complication was almost similar between the two groups. CONCLUSIONS D3 lymph node dissection provides better recurrence-free survival than D2 lymph node dissection after primary resection for elderly patients with pathological stage II and stage III colon cancer.
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Affiliation(s)
- Masakatsu Numata
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroyuki Saeki
- Department of Surgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masataka Taguri
- Department of Biostatistics, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takashi Oshima
- Department of Gastroenterological Surgery, Kanagawa Cancer Hospital, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-0815, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Manabu Shiozawa
- Department of Gastroenterological Surgery, Kanagawa Cancer Hospital, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-0815, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Short–term outcomes of laparoscopic colorectal cancer surgery in elderly patients. -Is it really safe in elderly patients with severe comorbidities?-. INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Inoue K, Ueno T, Akishige N, Soeta T, Tsuchiya T, Nakayama S, Shima K, Goto S, Takahashi M, Naitoh T, Naito H. What is the optimal risk scoring for predicting complications after colorectal surgery in elderly patients? INTERNATIONAL JOURNAL OF SURGERY OPEN 2019. [DOI: 10.1016/j.ijso.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Maeda H, Okamoto K, Oba K, Shiga M, Fujieda Y, Namikawa T, Hiroi M, Murakami I, Hanazaki K, Kobayashi M. Lymph node retrieval after dissolution of surrounding adipose tissue for pathological examination of colorectal cancer. Oncol Lett 2017; 15:2495-2500. [PMID: 29434964 DOI: 10.3892/ol.2017.7629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/24/2017] [Indexed: 02/05/2023] Open
Abstract
Examination of >12 lymph nodes (LNs) is important for the diagnostic accuracy of nodal status following resection of colorectal cancer. In the present study, the efficacy of a fat dissolution technique for LN retrieval was evaluated using resected colon and rectum mesentery. First, the resected mesentery was searched for LNs by inspection and palpation immediately after surgery. Subsequently, fat dissolution liquid was applied to the remnant fat and the LN search was repeated. The primary endpoint was whether the second assessment would increase the number of evaluated LNs. Recruitment of 20 patients was planned. The study was conducted after institutional review board approval and written informed consent was obtained. Among 20 participants, 1 patient was excluded because LN dissection was not performed. The median number of LNs identified at the first and second assessments was 13 and 6, respectively, producing a significant increase in total LNs evaluated (13 vs. 20, respectively; P<0.01; paired t-test). One positive node was identified among the additionally identified LNs (0.9%, 1/107). The second assessment increased the number of LNs assessed to >12 in 4 patients, and although staging was not changed, the treatment was potentially altered in 2 stage II patients. The maximum diameter of the additionally obtained LNs was significantly smaller compared with those from the first assessment (4 vs. 7.7 mm, respectively; P<0.01; Wilcoxon signed-rank test). After the fat dissolution technique, the tumor cells were satisfactorily stained by carcinoembryonic antigen and cytokeratin-20. In conclusion, applying fat dissolution liquid to the remnant adipose tissue of the mesentery of the colon and rectum identified additional LNs. This method should be considered when insufficient LNs are identified after conventional LN retrieval.
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Affiliation(s)
- Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi 783-8505, Japan
| | - Ken Okamoto
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi 783-8505, Japan
| | - Koji Oba
- Department of Biostatistics, Graduated School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan
| | - Mai Shiga
- Depatment of Surgery, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Yuki Fujieda
- Depatment of Surgery, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Tsutomu Namikawa
- Depatment of Surgery, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Makoto Hiroi
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Ichiro Murakami
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Kazuhiro Hanazaki
- Depatment of Surgery, Kochi Medical School, Kochi University, Kochi 783-8505, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Kochi 783-8505, Japan
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15
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Miguchi M, Yoshimitsu M, Hakoda K, Omori I, Kohashi T, Hihara J, Ohdan H, Hirabayashi N. Short-term outcomes of laparoscopic surgery in octogenarians with colorectal cancer: a single-institution analysis. Surg Today 2017; 48:292-299. [PMID: 28948374 DOI: 10.1007/s00595-017-1584-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/06/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE The number of elderly patients with colorectal cancer (CRC) treated with surgery has gradually increased. The aim of this study was to evaluate the short-term outcomes in patients ≥80 years of age who underwent laparoscopic or open surgery for CRC using a propensity score-matched analysis to make uniform the patient background characteristics affecting the postoperative morbidity and mortality. METHODS We compared the short-term outcomes of open vs. laparoscopic surgery in patients with CRC ≥80 years of age between 2010 and 2015. Fifty-two patients undergoing laparoscopic colectomy for CRC were matched to 52 patients undergoing open colectomy with respect to gender, age, body mass index, performance status, prognostic nutritional index, Charlson Comorbidity Index score, tumor-node-metastasis stage, and tumor location. The operative time, blood loss, length of hospital stay, and postoperative complications were investigated. RESULTS Blood loss was less during laparoscopic surgery than during open surgery (40 vs. 140 ml, p < 0.001). In the laparoscopic surgery group, the hospital stay was shorter (11 vs. 14 days, p < 0.001) and the morbidity rate lower (21.2 vs. 40.4%) than in the open surgery group. The mortality for both groups was similar (0 vs. 1.9% for laparoscopic surgery vs. open surgery). CONCLUSION Laparoscopic surgery in octogenarians with CRC is a safe, low-invasive alternative to open surgery with less blood loss and a shorter hospital stay.
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Affiliation(s)
- Masashi Miguchi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan.
| | - Keishi Hakoda
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Ichiro Omori
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Toshihiko Kohashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoki Hirabayashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, 2-1-1 Kabeminami, Asakita-ku, Hiroshima, 731-0293, Japan
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Hata T, Takahashi H, Sakai D, Haraguchi N, Nishimura J, Kudo T, Chu M, Takemasa I, Taroh S, Mizushima T, Doki Y, Mori M. Neoadjuvant CapeOx therapy followed by sphincter-preserving surgery for lower rectal cancer. Surg Today 2017; 47:1372-1377. [PMID: 28474202 DOI: 10.1007/s00595-017-1527-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/13/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE This retrospective study investigates the safety of neoadjuvant chemotherapy with oxaliplatin capecitabine (CapeOx), followed by laparoscopic surgery, for lower rectal cancer, and its efficacy in preserving the sphincter. METHODS Ten patients with diagnosed lower rectal cancer received three or four cycles of neoadjuvant CapeOx chemotherapy, prior to undergoing low anterior resection or intersphincteric resection, with total mesorectal excision. The primary outcomes were R0 resection and the rate of sphincter preservation. RESULTS Nine patients completed CapeOx as scheduled and a partial response was achieved in four; thus, the overall response rate was 40% (n = 4/10). After surgical intervention, 80% of tumors displayed downstaging. Postoperative anastomosis leakage developed in one patient. The distance from the anal verge to the tumor increased by 60% (median 1.5 cm) after CapeOx treatment. The anal sphincter was preserved in all patients and all pathological distal and radial margins were negative (R0 resections). A pathological complete response was achieved in one patient. CONCLUSIONS Neoadjuvant CapeOx chemotherapy is a promising approach, because it extended the distance from the anus to the tumor. Subsequent laparoscopic intervention for advanced lower rectal cancer could allow for safe preservation of the sphincter.
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Affiliation(s)
- Taishi Hata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Sakai
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toshihiro Kudo
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Matsuda Chu
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Graduate School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Satoh Taroh
- Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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17
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Surgery or stereotactic body radiotherapy for elderly stage I lung cancer? A propensity score matching analysis. Surg Today 2017; 47:1476-1483. [DOI: 10.1007/s00595-017-1536-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/17/2017] [Indexed: 12/25/2022]
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18
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Risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery. Surg Today 2017; 47:1238-1242. [DOI: 10.1007/s00595-017-1510-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/12/2017] [Indexed: 12/11/2022]
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19
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Tanaka K, Okuda J, Yamamoto S, Ito M, Sakamoto K, Kokuba Y, Yoshimura K, Watanabe M. Risk factors for anastomotic leakage after laparoscopic surgery with the double stapling technique for stage 0/I rectal carcinoma: a subgroup analysis of a multicenter, single-arm phase II trial. Surg Today 2017; 47:1215-1222. [PMID: 28280982 DOI: 10.1007/s00595-017-1496-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/07/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to determine the risk factors for anastomotic leakage after laparoscopic rectal surgery. METHODS We conducted a prospective trial involving 395 patients with stage 0/I rectal carcinoma who underwent laparoscopic low anterior resection using a double stapling technique. Data concerning variables related to patient background, tumors and surgical factors were evaluated. The outcomes with respect to anastomotic leakage were recorded, and univariate and multivariate analyses were performed to identify relevant risk factors. RESULTS The overall anastomotic leakage rate was 8.4%. A univariate analysis showed male gender (P = 0.006) and preoperative blood sugar level (P = 0.0034) to be significantly associated with anastomotic leakage. The variables of gender, preoperative blood sugar level, American Society of Anesthesiologists (ASA) classification (P = 0.15), transanal decompression tube (P = 0.06) and number of stapler cartridges used for rectal transection (P = 0.18) were selected for the multivariate analysis because of their P values being <0.2. The multivariate analysis identified male gender (odds ratio 4.12, P = 0.006) and the absence of a transanal decompression tube (odds ratio 3.11, P = 0.0484) as independent risk factors predicting anastomotic leakage. CONCLUSIONS Male gender and the absence of a transanal decompression tube appeared to be independent risk factors for anastomotic leakage. Insertion of a transanal decompression tube may help prevent anastomotic leakage after low anterior resection, particularly in male patients.
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Affiliation(s)
- Keitaro Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Junji Okuda
- Cancer Center, Osaka Medical College Hospital, Osaka, Japan
| | - Seiichiro Yamamoto
- Division of Gastroenterological Surgery, Hiratsuka City Hospital, 19-1-1, Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan.
| | - Masaaki Ito
- Colorectal Surgery Division, National Cancer Center Hospital East, Chiba, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University, Tokyo, Japan
| | - Yukihito Kokuba
- Department of Gastroenterological Surgery, St. Marianna University Yokohama West Hospital, Kanagawa, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University Hospital, Ishikawa, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Hospital, Kanagawa, Japan
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