Analysis of Risk Factors for Anastomotic Leakage after Lower Rectal Cancer Resection, Including Drain Type: A Retrospective Single-Center Study

Abstract

Background: We investigated the correlations between surgery-related factors and the incidence of leakage after low anterior resection (LAR) for lower rectal cancer.Methods: A total of 630 patients underwent colorectal surgery between 2011 and 2014 in our department. Of these, 97 patients (15%) underwent LAR and were included in this retrospective study. Temporary ileostomy was performed in each patient.Results: Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed that operative duration (p=0.0051), transanal hand-sewn anastomosis (p=0.0141), and operation procedure (p=0.0191) were significantly associated with the occurrence of leakage. Multivariate analysis showed that underlying disease (p=0.0440), transanal hand-sewn anastomosis (p=0.0188) and drain type (p=0.0251) were significantly associated with the occurrence of leakage. Propensity-score analysis showed that closed drainage was associated with 6.3 times with anastomotic leakage than open drainage in patients, according to inverse probability of treatment-weighted analysis. Conclusions: Our results indicate that underlying disease, transanal hand-sewn anastomosis, and drain type may be risk factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that the type of drainage was related to the occurrence of anastomotic leakage: closed drainage was correlated with the less volume of postoperative drain discharge than open drain.

Retrospective study of active drainage in the management of anastomotic leakage after anterior resection for rectal cancer

“…This speculation is consistent with a previous report by Kinugasa et al. 25 indicating that open drainage was associated with a much lower incidence of postoperative leakage compared with closed drainage.…”

“…The hospital stay in the passive drainage group was comparable to the average hospital stay associated with AL (36.2 days) reported by Shinji et al 24 We speculate that active drainage can effectively eliminate intestinal excretions, thereby reducing the incidence of serious complications, such as infection and erosion of the anastomosis, and promote spontaneous AL resolution. This speculation is consistent with a previous report by Kinugasa et al 25 indicating that open drainage was associated with a much lower incidence of postoperative leakage compared with closed drainage.…”