Determining the protective characteristics and risk factors for the development of anastomotic leakage after low anterio
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ORIGINAL ARTICLE
Determining the protective characteristics and risk factors for the development of anastomotic leakage after low anterior resection for rectal cancer Nobuaki Suzuki1 · Shin Yoshida1 · Shinobu Tomochika1 · Yuki Nakagami1,2 · Yoshitaro Shindo1 · Yukio Tokumitsu1 · Michihisa Iida1 · Shigeru Takeda1 · Shoichi Hazama1,2 · Tomio Ueno3 · Hiroaki Nagano1 Received: 22 June 2020 / Accepted: 20 August 2020 © The Author(s) 2020
Abstract Purpose Anastomotic leakage is one of the most serious postoperative complications associated with surgery for rectal cancer. The present study aimed to identify the protective characteristics and risk factors associated with anastomotic leakage after low anterior resection for rectal cancer. Methods This was a retrospective, single-center study conducted between January 2009 and December 2017 at our institution. In total, 136 rectal cancer patients who underwent low anterior resection were included in the study. We analyzed preoperative and intraoperative factors. In addition, the pelvic dimensions were measured using computed tomography in all cases. Results Among the 136 patients, anastomotic leakage occurred in 21 (15.4%), including 18 males and 3 females. The median body mass index was 21.1 kg/m2. The construction of a covering stoma was found to be a protective factor. In addition, the operation time (≥ 373 min), intraoperative blood loss (≥ 105 ml), and size of the pelvic inlet (≥ 113 mm) were identified as risk factors for anastomotic leakage. Conclusion The construction of a covering stoma was a possible protective factor. However, a longer operation time, higher intraoperative blood loss, and larger pelvic inlet dimensions were possible risk factors for developing anastomotic leakage after low anterior resection in patients with rectal cancer. Keywords Colorectal surgery · Anastomotic leak · Risk factor · Rectal cancer · Pelvic index
Introduction Advances in surgical procedures and adjuvant therapies have made sphincter-preserving surgery the standard operation for most patients with rectal cancer. Heald et al. introduced a new method called total mesorectal excision (TME) for the treatment of rectal cancer. TME as a novel surgical method is important for preventing injury to the fascia propria of * Hiroaki Nagano hnagano@yamaguchi‑u.ac.jp 1
Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
2
Department of Translational Research and Developmental Therapeutics Against Cancer, Yamaguchi University School of Medicine, Ube, Japan
3
Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Japan
the rectum. At present, this technique is considered the gold standard for managing rectal cancer surgery [1–3]. Anastomotic leakage (AL) is a postoperative complication that occurs in patients who undergo low anterior resection (LAR) for rectal cancer [4–6]. AL leads to several serious postoperative complications, including peritonitis, sepsis, need for re-operation or per
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