Hui Qu1, Yao Liu2, Dong-song Bi3. 1. Department of General Surgery, Shandong University Qilu Hospital, No.107 of the West Cultural Road, Jinan, 250012, Shandong, China. doctorquhui@126.com. 2. Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China. 3. Department of General Surgery, Shandong University Qilu Hospital, No.107 of the West Cultural Road, Jinan, 250012, Shandong, China. 18560085120@163.com.
Abstract
BACKGROUND: Anastomotic leakage (AL) is a serious complication in laparoscopic rectal cancer surgery, and risk factors for AL are not well defined. Herein, we conducted a systematic review to quantify the clinicopathologic factors predictive for AL in patients who underwent laparoscopic anterior resection (LAR) for rectal cancer. METHODS: A systematic search of electronic databases (PubMed, Embase, Cochrane CENTRAL, Scopus Database, and Wanfang Database) for studies published until August 2014 was performed. Cohort, case-control studies, and randomized controlled trials that examined clinical risk factors for AL were included. RESULTS: Fourteen studies (seven prospective and seven retrospective studies) involving 4580 patients met final inclusion criteria. From the pooled analyses, five demographic factors were found to be significantly associated with the development of AL, including male gender (OR 2.04, 95% CI 1.50-2.77), BMI ≥25 kg/m(2) (OR 1.46, 95% CI 1.00-2.14), ASA score >2 (OR 1.74, 95% CI 1.04-2.93, P = 0.04), tumor size >5 cm (OR 1.63, 95% CI 1.01-2.64, P = 0.05), and preoperative chemotherapy (OR 1.67, 95% CI 1.10-2.55, P = 0.02). Four operative factors were significantly associated with increased risk of AL, including longer operative time (95% CI 1.71-5.77, P = 0.0002), number of stapler firings ≥3 (OR 0.17, 95% CI 0.07-0.41, P < 0.001), intra-operative transfusions/blood loss >100 mL (OR 3.79, 95% CI 2.48-5.49, P < 0.001), and anastomosis level within 5 cm from the anal verge (OR 9.63, 95% CI 3.05-30.43, P = 0.0001), while pelvic drain (OR 0.43, 95% CI 0.19-0.94, P = 0.04) was significantly associated with a lower AL rate. CONCLUSION: Our analysis identified several clinicopathologic factors associated with AL in patients who underwent LAR. The knowledge of these risk factors may influence treatment- and procedure-related decisions and possibly reduce the leakage rate.
BACKGROUND: Anastomotic leakage (AL) is a serious complication in laparoscopic rectal cancer surgery, and risk factors for AL are not well defined. Herein, we conducted a systematic review to quantify the clinicopathologic factors predictive for AL in patients who underwent laparoscopic anterior resection (LAR) for rectal cancer. METHODS: A systematic search of electronic databases (PubMed, Embase, Cochrane CENTRAL, Scopus Database, and Wanfang Database) for studies published until August 2014 was performed. Cohort, case-control studies, and randomized controlled trials that examined clinical risk factors for AL were included. RESULTS: Fourteen studies (seven prospective and seven retrospective studies) involving 4580 patients met final inclusion criteria. From the pooled analyses, five demographic factors were found to be significantly associated with the development of AL, including male gender (OR 2.04, 95% CI 1.50-2.77), BMI ≥25 kg/m(2) (OR 1.46, 95% CI 1.00-2.14), ASA score >2 (OR 1.74, 95% CI 1.04-2.93, P = 0.04), tumor size >5 cm (OR 1.63, 95% CI 1.01-2.64, P = 0.05), and preoperative chemotherapy (OR 1.67, 95% CI 1.10-2.55, P = 0.02). Four operative factors were significantly associated with increased risk of AL, including longer operative time (95% CI 1.71-5.77, P = 0.0002), number of stapler firings ≥3 (OR 0.17, 95% CI 0.07-0.41, P < 0.001), intra-operative transfusions/blood loss >100 mL (OR 3.79, 95% CI 2.48-5.49, P < 0.001), and anastomosis level within 5 cm from the anal verge (OR 9.63, 95% CI 3.05-30.43, P = 0.0001), while pelvic drain (OR 0.43, 95% CI 0.19-0.94, P = 0.04) was significantly associated with a lower AL rate. CONCLUSION: Our analysis identified several clinicopathologic factors associated with AL in patients who underwent LAR. The knowledge of these risk factors may influence treatment- and procedure-related decisions and possibly reduce the leakage rate.
Authors: K C M J Peeters; R A E M Tollenaar; C A M Marijnen; E Klein Kranenbarg; W H Steup; T Wiggers; H J Rutten; C J H van de Velde Journal: Br J Surg Date: 2005-02 Impact factor: 6.939
Authors: B Lefebure; J J Tuech; V Bridoux; B Costaglioli; M Scotte; P Teniere; F Michot Journal: Int J Colorectal Dis Date: 2007-09-02 Impact factor: 2.571
Authors: Sami A Chadi; Abe Fingerhut; Mariana Berho; Steven R DeMeester; James W Fleshman; Neil H Hyman; David A Margolin; Joseph E Martz; Elisabeth C McLemore; Daniela Molena; Martin I Newman; Janice F Rafferty; Bashar Safar; Anthony J Senagore; Oded Zmora; Steven D Wexner Journal: J Gastrointest Surg Date: 2016-09-16 Impact factor: 3.452
Authors: I Mizrahi; F B de Lacy; M Abu-Gazala; L M Fernandez; A Otero; D R Sands; A M Lacy; S D Wexner Journal: Tech Coloproctol Date: 2018-11-14 Impact factor: 3.781
Authors: Ulrich Wirth; Susanne Rogers; Kristina Haubensak; Stefan Schopf; Thomas von Ahnen; Hans Martin Schardey Journal: Int J Colorectal Dis Date: 2017-11-08 Impact factor: 2.571
Authors: Jachym Rosendorf; Marketa Klicova; Lenka Cervenkova; Richard Palek; Jana Horakova; Andrea Klapstova; Petr Hosek; Vladimira Moulisova; Lukas Bednar; Vaclav Tegl; Ondrej Brzon; Zbynek Tonar; Vladislav Treska; David Lukas; Vaclav Liska Journal: In Vivo Date: 2021 Mar-Apr Impact factor: 2.155
Authors: V Pla-Martí; J Martín-Arévalo; D Moro-Valdezate; S García-Botello; I Mora-Oliver; R Gadea-Mateo; C Cozar-Lozano; A Espí-Macías Journal: Tech Coloproctol Date: 2020-09-10 Impact factor: 3.781