Wei Zhang3, Zheng Lou1, Qizhi Liu1, Ronggui Meng1, Haifeng Gong1, Liqiang Hao1, Peng Liu1, Ge Sun1, Jun Ma1, Wei Zhang3. 1. Department of Colorectal Surgery, Changhai Hospital, Changhai Road 168#, Shanghai, China. 2. Department of Gastrointestinal Surgery, People's Hospital of Henan Province, Weiwu Road 7#, Zhengzhou, China. 3. Department of Colorectal Surgery, Changhai Hospital, Changhai Road 168#, Shanghai, China. weizhang2000cn@163.com.
Abstract
PURPOSE: The purpose of this study was to evaluate the risk factors for anastomotic leakage (AL) after anterior resection for middle and low rectal cancer in order to help surgeons to decide which patients could benefit from a diverting stoma. METHODS: Data on 319 patients having a middle and low rectal cancer resection with anastomosis between May 2011 and October 2015 from two hospitals were included in the study. The analysis included the following variables: patient-related variables (gender, age, diabetes mellitus, ASA score, preoperative radiochemotherapy, body mass index, blood hemoglobin, and serum albumin level), tumor-related variables (K-ras status, distance of tumor from the anal verge, histopathologic grade, pathological T stage, pathological N stage, pathological M stage, TNM stage, and tumor size), and surgery-related variables (laparoscopic or open surgery, blood loss, and operative time). Univariate and multivariate regression analysis were carried out to identify risk factors for AL. RESULTS: The AL rate was 11.91% (38/319). Male (OR 2.898, 95% CI 1.265-6.637, p = 0.012), diabetes mellitus (OR 2.482, 95% CI 1.004-6.134, p = 0.049), K-ras mutation (OR 2.544, 95% CI 1.210-5.348, p = 0.014), distance of tumor from the anal verge (OR 3.445, 95% CI 1.631-7.279, p = 0.001), and preoperative radiochemotherapy (OR 2.790, 95% CI 1.056-7.372, p = 0.039) were independent risk factors of AL. One (2.63%) in 38 patients with AL presented with no risk factor of AL, 6 (15.8%) in 38 patients with 1 risk factor, 16 (42.1%) in 38 patients with 2 risk factors, 9 (23.7%) in 38 patients with 3 risk factors, and 6 (15.7%) in 38 patients with 4 risk factors. No patient with 5 risk factors in our study. AL rate increased with the elevated number of risk factors clustering in individuals. CONCLUSIONS: K-ras mutation is first reported to be an independent risk factor for AL after sphincter-preserving surgery without diverting stoma. A diverting stoma should be performed in sphincter-preserving surgery for middle and low rectal cancer patients with 2 or more risk factors identified in this analysis.
PURPOSE: The purpose of this study was to evaluate the risk factors for anastomotic leakage (AL) after anterior resection for middle and low rectal cancer in order to help surgeons to decide which patients could benefit from a diverting stoma. METHODS: Data on 319 patients having a middle and low rectal cancer resection with anastomosis between May 2011 and October 2015 from two hospitals were included in the study. The analysis included the following variables: patient-related variables (gender, age, diabetes mellitus, ASA score, preoperative radiochemotherapy, body mass index, blood hemoglobin, and serum albumin level), tumor-related variables (K-ras status, distance of tumor from the anal verge, histopathologic grade, pathological T stage, pathological N stage, pathological M stage, TNM stage, and tumor size), and surgery-related variables (laparoscopic or open surgery, blood loss, and operative time). Univariate and multivariate regression analysis were carried out to identify risk factors for AL. RESULTS: The AL rate was 11.91% (38/319). Male (OR 2.898, 95% CI 1.265-6.637, p = 0.012), diabetes mellitus (OR 2.482, 95% CI 1.004-6.134, p = 0.049), K-ras mutation (OR 2.544, 95% CI 1.210-5.348, p = 0.014), distance of tumor from the anal verge (OR 3.445, 95% CI 1.631-7.279, p = 0.001), and preoperative radiochemotherapy (OR 2.790, 95% CI 1.056-7.372, p = 0.039) were independent risk factors of AL. One (2.63%) in 38 patients with AL presented with no risk factor of AL, 6 (15.8%) in 38 patients with 1 risk factor, 16 (42.1%) in 38 patients with 2 risk factors, 9 (23.7%) in 38 patients with 3 risk factors, and 6 (15.7%) in 38 patients with 4 risk factors. No patient with 5 risk factors in our study. AL rate increased with the elevated number of risk factors clustering in individuals. CONCLUSIONS:K-ras mutation is first reported to be an independent risk factor for AL after sphincter-preserving surgery without diverting stoma. A diverting stoma should be performed in sphincter-preserving surgery for middle and low rectal cancerpatients with 2 or more risk factors identified in this analysis.
Authors: Bruno Vincenzi; Chiara Cremolini; Andrea Sartore-Bianchi; Antonio Russo; Francesco Mannavola; Giuseppe Perrone; Francesco Pantano; Fotios Loupakis; Daniele Rossini; Elena Ongaro; Erica Bonazzina; Emanuela Dell'Aquila; Marco Imperatori; Alice Zoccoli; Giuseppe Bronte; Giovanna De Maglio; Gabriella Fontanini; Clara Natoli; Alfredo Falcone; Daniele Santini; Andrea Onetti-Muda; Salvatore Siena; Giuseppe Tonini; Giuseppe Aprile Journal: Oncotarget Date: 2015-10-13
Authors: M den Dulk; C A M Marijnen; L Collette; H Putter; L Påhlman; J Folkesson; J-F Bosset; C Rödel; K Bujko; C J H van de Velde Journal: Br J Surg Date: 2009-09 Impact factor: 6.939
Authors: Johannes Klose; Ignazio Tarantino; Armin von Fournier; Moritz J Stowitzki; Yakup Kulu; Thomas Bruckner; Claudia Volz; Thomas Schmidt; Martin Schneider; Markus W Büchler; Alexis Ulrich Journal: J Gastrointest Surg Date: 2018-05-18 Impact factor: 3.452
Authors: C Simillis; M Charalambides; A Mavrou; T Afxentiou; M P Powar; J Wheeler; R J Davies; N S Fearnhead Journal: Tech Coloproctol Date: 2022-09-22 Impact factor: 3.699
Authors: Maximilian Brunner; Alaa Zu'bi; Klaus Weber; Axel Denz; Melanie Langheinrich; Stephan Kersting; Georg F Weber; Robert Grützmann; Christian Krautz Journal: Int J Colorectal Dis Date: 2022-06-15 Impact factor: 2.796
Authors: Maria Charalambides; Athina Mavrou; Thomas Jennings; Michael P Powar; James Wheeler; R Justin Davies; Nicola S Fearnhead; Constantinos Simillis Journal: Int J Colorectal Dis Date: 2021-10-26 Impact factor: 2.571
Authors: Jacqueline van den Bos; Audrey C H M Jongen; Jarno Melenhorst; Stéphanie O Breukink; Kaatje Lenaerts; Rutger M Schols; Nicole D Bouvy; Laurents P S Stassen Journal: Surg Endosc Date: 2019-02-01 Impact factor: 4.584
Authors: Mateusz Rubinkiewicz; Jan Witowski; Michał Wysocki; Magdalena Pisarska; Stanisław Kłęk; Andrzej Budzyński; Michał Pędziwiatr Journal: J Clin Med Date: 2019-10-01 Impact factor: 4.241