Risk factors for anastomotic leakage following rectal resection – Multicenter study
Authors:
J. Kotoč 1; K. Kotočová 1; J. Gatěk 1
; A. Vrzgula 2; V. Pribula 2; M. Hladík 3; J. Olejník 3
Authors place of work:
Chirurgické oddělení, Nemocnice Atlas, a. s., Zlín, primář: MUDr. J. Gatěk, Ph. D
1; Chirurgická klinika LF UPJŠ, Nemocnica Košice-Šaca, a. s., 1. súkr. nemocnica, Košice-Šaca
přednosta: MUDr. A. Vrzgula, PhD.
2; Chirurgická klinika SZU, Nemocnica akademika L. Dérera, Bratislava, přednosta: prof. MUDr. J. Olejník, PhD.
3
Published in the journal:
Rozhl. Chir., 2014, roč. 93, č. 12, s. 578-582.
Category:
Original articles
Summary
Introduction:
Anastomotic insufficiency (anastomotic leakage) is one of the most serious complications of the sphincter-saving rectal resections, with significant impact on patient morbidity and mortality. The risk rate of anastomotic leakage may be influenced by local anatomic conditions – tumour localisation and stage, possible technical problems in anastomosis construction (ischaemia, anastomosis under tension), and by complex factors associated with the patient – malnutrition, obesity, smoking, corticosteroid therapy and preoperative chemoradiation.
Material and methods:
All sphincter-saving rectal resections that were performed between September 2011 and April 2014 in three centres of colorectal surgery, i.e. at Atlas Hospital in Zlín, the Czech Republic, and at Košice-Šaca Hospital and Dérer’s University Hospital in Bratislava, Slovakia, were included in the present multicentric prospective study. The incidence of anastomotic leakage in laparoscopic and open surgery was compared and the risk factors resulting in leakage occurrence were analyzed.
Results:
Anastomotic leakage developed in 12 (10.9%) out of the total number of 110 patients. In the laparoscopic group (58 patients), the insufficiency occurred 4x (6.9%), in the 17 converted patients 3x (17.6%), and in the open surgery group (35 patients) the leakage occurred 5x (14.3%). There was no statistically significant difference between these groups. Nevertheless, patients with anastomotic leakage were only males (P=0.006), they had significantly lower pre-operative albumin levels (35.8 g/l vs. 38.3 g/l; P=0.03), as well as a lower pre-operative total protein level (60.8 g/l vs. 64.1 g/l; P=0.07), when compared to patients without insufficiency. Tumour distance from the anal verge in patients with anastomotic leakage was also significantly lower (10.8 cm vs. 12.8 cm; P=0.05).
Conclusion:
The following risk factors for anastomotic insufficiency after rectal surgery were identified: male gender, low pre-operative albumin and total protein levels, as well as decreasing tumour distance from the anal verge. The difference in the incidence of anastomotic insufficiency between laparoscopic and open surgery groups was not statistically significant.
Key words:
anastomotic leakage – rectal resection – risk factors
Zdroje
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