A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

Effect of anastomotic reinforcement with barded suture on anastomotic leakage prevention following laparoscopic low anterior resection for rectal cancer: a retrospective single-center study

BACKGROUND

Anastomotic leakage (AL) is a serious complication that may occur following the double stapling technique (DST). The study aims to investigate the efficacy of anastomotic reinforcement using barbed sutures in preventing AL after laparoscopic low anterior resection (LAR) for rectal cancer.

METHODS

During the period from November 1, 2018 to November 1, 2023, a total of 725 consecutive patients who had underwent laparoscopic LAR for rectal cancer were enrolled in this study. The patients were divided into two groups: the continuous barbed suture reinforcement group (N = 296) and the control group (N = 429). Inter-group comparisons were used the chi-squared test, Fisher's exact test, and nonparametric tests. Independent risk or protective factors for AL were analyzed using the multivariate logistic regression.

RESULTS

Among the 725 patients enrolled in this study, 24 patients (3.3%) were diagnosed with AL following surgery. The incidence of AL was lower in the reinforcement group when compared with the control group (1.4% vs. 4.7%, P = 0.014). In multivariate regression analyses, the neoadjuvant therapy (OR = 11.994, P < 0.01), tumor location (OR = 5.306, P = 0.015), anastomosis bleeding (OR = 58.822, P < 0.01), and number of staple firings used (≥ 3) (OR = 24.752, P < 0.01) were independent risk factors for AL, whereas the defunctioning stoma (OR = 0.051, P < 0.01) and reinforcing sutures (OR = 0.054, P = 0.001) were independent protective factors for AL in this study. No statistically significant differences were found in 36-item short-Form (SF-36) when evaluating the quality of patient's life between the two groups.

CONCLUSIONS

Laparoscopic continuous barbed suture reinforcement of anastomosis could reduce the incidence of AL without affecting the quality-of-life following LAR. Further popularization of this approach in clinical is warranted.

TRIAL REGISTRATION

Retrospectively registered.

Risk assessment of rectal anastomotic leakage (RAREAL) after DIXON in non-emergency patients with rectal cancer

BACKGROUND

The routine establishment of a diverting stoma (DS) remains controversial in every patient undergoing Dixon operation. We aimed to establish a model for the risk assessment of rectal anastomotic leak (RAREAL) after Dixon in non-emergency patients with rectal cancer, using routinely available variables, by which surgeons could individualize their approach to DS.

METHODS

323 patients who underwent Dixon operation for rectal cancer from January 2015 to December 2018 were taken as the model group for retrospective study. Univariable and multivariable logistic regression analysis was used to determine the independent risk factors associated with anastomotic leakage. We constructed the RAREAL model. 150 patients who underwent Dixon operation due to rectal cancer from January 2019 to December 2020 were collected according to the uniform criteria as a validation group to validate the RAREAL model.

RESULTS

In the model group, multivariable analysis identified the following variables as independent risk factors for AL: HbA1c (odds ratio (OR) = 4.107; P = 0.044), Left colic artery (LCA) non preservation (OR = 4.360; P = 0.026), Tumor distance from the anal margin (TD) (OR = 6.373; P = 0.002). In the model group, the area under the curve (AUC) of the receiver operating characteristic (ROC) for evaluating AL with RAREAL was 0.733, and when RAREAL score = 2.5, its sensitivity, specificity and Youden index were 0.385, 0.973, 0.358, respectively. The AUC was 0.722 in the validation group and its sensitivity and specificity were 0.333 and 0.985, respectively, when RAREAL score = 2.5.

CONCLUSION

The RAREAL score can be used to assess the risk of AL after Dixon operation for rectal cancer, and prophylactic DS should be proactively done when the score is greater than 2.5.

Analysis of Risk Factors for Anastomotic Leakage After Laparoscopic Anterior Resection of Rectal Cancer and Construction of a Nomogram Prediction Model

Objective

To explore the risk factors of anastomotic leakage (AL) after laparoscopic anterior resection (AR) of rectal cancer and establish a nomogram prediction model.

Methods

Clinical and surgical data of patients who underwent AR of rectal cancer at Sichuan Cancer Hospital from January 2017 to December 2020 were retrospectively collected. Univariate and multivariate logistic regression analyses were used to screen the independent risk factors of AL after AR. A nomogram risk prediction model was established based on the selected independent risk factors and the predictive performance of nomogram was evaluated.

Results

A 1013 patients undergoing laparoscopic AR were included, of which 67 had AL, with an incidence of 6.6%. Univariate and multivariate logistic regression analyses showed that male gender, tumors distance from the anus verge of ≤ 5cm, tumors distance from the anus verge of 5–10cm, circumferential tumor growth, operation time ≥ 240min, and no diverting stoma were independent risk factors for AL after AR. A nomogram prediction model was established based on these results. The calibration curve showed that the predicted occurrence probability of the nomogram model was in good agreement with the actual occurrence probability. The area under the receiver operating characteristic (ROC) curve was 0.749.

Conclusion

The nomogram prediction model based on the independent risk factors of patients undergoing AL after AR can effectively predict the probability of AL.

Risk factors of symptomatic anastomotic leakage and its impacts on a long-term survival after laparoscopic low anterior resection for rectal cancer: a retrospective single-center study

Background

Postoperative symptomatic anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) for rectal cancer. AL can potentially affect short-term patient outcomes and long-term prognosis. This study aimed to explore the risk factors and long-term survival of symptomatic AL after laparoscopic LAR for rectal cancer.

Methods

From May 2009 to May 2015, 298 consecutive patients who underwent laparoscopic LAR for rectal cancer with or without a defunctioning stoma were included in this study. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for symptomatic AL. Survival analysis was performed using Kaplan–Meier curves, and log-rank tests were used for group comparisons.

Results

Among the 298 patients enrolled in this study, symptomatic AL occurred in eight (2.7%) patients. The univariate analysis showed that age of ≤65 years (P = 0.048), neoadjuvant therapy (P = 0.095), distance from the anal verge (P = 0.078), duration of operation (P = 0.001), and pathological tumor (T) category (P = 0.004) were associated with symptomatic AL. The multivariate analysis demonstrated that prolonged duration of operation (P = 0.010) was an independent risk factor for symptomatic AL after laparoscopic LAR for rectal cancer. No statistically significant differences were observed in the 3-year (P = 0.785) and 5-year (P = 0.979) overall survival rates.

Conclusions

A prolonged duration of operation increased the risk of symptomatic AL after laparoscopic LAR for rectal cancer. An impact of symptomatic AL on a long-term survival was not observed in this study; however, further studies are required.

Trial registration

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033413) on May 31, 2020.