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Multicenter Analysis of Risk Factors for Anastomotic Leakage After Laparoscopic Rectal Cancer Excision The Korean Laparoscopic Colorectal Surgery Study Group

Authors
Park, Jun SeokChoi, Gyu-SeogKim, Seon HahnKim, Hyeong RokKim, Nam KyuLee, Kang YoungKang, Sung BumKim, Ji YeonLee, Kil YeonKim, Byung ChunBae, Byung NoeSon, Gyung MoLee, Sun Il.Kang, Hyun
Issue Date
Apr-2013
Publisher
LIPPINCOTT WILLIAMS & WILKINS
Keywords
anastomotic leakage; laparoscopic surgery; rectal cancer; risk factor
Citation
ANNALS OF SURGERY, v.257, no.4, pp 665 - 671
Pages
7
Journal Title
ANNALS OF SURGERY
Volume
257
Number
4
Start Page
665
End Page
671
URI
https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/14721
DOI
10.1097/SLA.0b013e31827b8ed9
ISSN
0003-4932
1528-1140
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.
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