Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer: a propensity score matching analysis of 1014 consecutive patients

Katsuno, Hidetoshi; Shiomi, Akio; Ito, Masaaki; Koide, Yuji; Maeda, Koutarou; Yatsuoka, Toshimasa; Hase, Kazuo; Kono, Koji; Minami, Kazuhito; Sakamoto, Kazuhiro; Saida, Yoshihisa; Saitô, Norio

doi:10.1007/s00464-015-4566-2

Cited by 55 publications

(47 citation statements)

References 26 publications

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“…Rectal transection using the laparoscopic approach is a difficult technique that requires much skill; any mistakes during the procedure could directly lead to AL. Previous studies have proposed several potential risk factors for AL including male sex, transanal tube insertion, tumor location, operative time, tumor size, recompression before stapler firings, and BMI . In this study, we identified two risk factors associated with AL occurrence: male sex and AV distance ≤7 cm.…”

Section: Discussionmentioning

confidence: 87%

Preventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratification

Hamabe

Ito

Nishigori

et al. 2017

Asian J Endoscop Surgery

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Section: Discussionmentioning

confidence: 87%

Preventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratification

Hamabe

Ito

Nishigori

et al. 2017

Asian J Endoscop Surgery

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“…In addition, a lower tumor position increases the difficulty of the operation. Excessive intraoperative blood loss would not only affect postoperative healing but also affects the difficulty of performing the procedure in the surgical field . The change in immune function caused by blood loss may also be one of the potential mechanisms that affects AL.…”

Section: Discussionmentioning

confidence: 99%

Novel nomogram with microvascular density in the surgical margins can accurately predict the risk for anastomotic leakage after anterior resection for rectal cancer

Xiao

Zhou

Yang

et al. 2019

Journal of Surgical Oncology

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Abstracts Background Anastomotic leakage (AL) is a serious complication after anterior resection. The purpose of this study was to determine the role of microvascular density (MVD) in AL and to develop a nomogram to accurately predict AL. Methods This study retrospectively enrolled 477 consecutive patients who underwent anterior resection for rectal cancer from January 2011 to January 2019. Tissue samples of the resection margins were assessed for MVD. Univariate and multivariate regression analyses were used to identify the risk factors for AL. Results The incidence of clinical AL was 6.7%. MVD in the distal margin was associated with AL (P < .001). Univariate and multivariate regression analysis identified the following variables as independent risk factors for AL: preoperative albumin ≤35 g/L (odds ratio [OR] = 2.511), neoadjuvant treatment (OR = 3.560), location of tumor ≤7 cm (OR = 3.381), blood loss ≥100 mL (OR = 2.717), and MVD in the distal margin ≤20 (OR = 4.265). Then, a nomogram including these predictors was developed. The nomogram showed good discrimination (AUC = 0.816) and calibration (concordance index = 0.816). The decision curve analysis demonstrated that the nomogram was clinically useful. Conclusions MVD in the distal margin is closely associated with AL. The nomogram can be used for individualized prediction of AL after anterior resection for patients with rectal cancer.

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“…Surgery is an effective treatment for colorectal cancer (CRC) (1,2), and certain procedures, such as low anterior resection and intersphincteric resection for lower rectal cancer, require an ileostomy to reduce the risk of severe anastomotic leakage (3)(4)(5). High-output ileostomy (HOI) is often observed and is accompanied by electrolyte abnormalities and/or stoma complications (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

Fujino

Miyoshi

Ohue

et al. 2017

Molecular and Clinical Oncology

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Abstract. The aim of the present study was to examine the risk factors of high-output ileostomy (HOI), which is associated with electrolyte abnormalities and/or stoma complications, and to create a prediction model. The medical records of 68 patients who underwent colorectal cancer surgery with ileostomy between 2011 and 2016 were retrospectively investigated. All the patients underwent surgical resection for colorectal cancer at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan). A total of 7 patients with inadequate data on ileostomy output were excluded. Using a group of 50 patients who underwent surgery between 2011 and 2013, the risk of HOI was classified by a decision tree model using a partition platform. The HOI prediction model was validated in an additional group of 11 patients who underwent surgery between 2014 and 2016. Univariate analysis of clinical factors demonstrated that young age (P=0.003) and high white blood cell (WBC) count (P<0.001) after surgery were significantly correlated with HOI. Operative factors, such as surgical procedure, approach, operative time and blood loss, were not significantly correlated with HOI. Using these clinical factors, the risk of HOI was classified by statistical partition. In this model, three factors (gender, age and WBC on postoperative day 1) were generated for the prediction of HOI. The patients were classified into five groups, and HOI was observed in 0-88% of patients in each group. The area under the curve (AUC) was 0.838. The model was validated by an external dataset in an independent patient group, for which the AUC was 0.792. In conclusion, HOI patients were classified and an HOI prediction model was developed that may help clinicians in postoperative care. IntroductionSurgery is an effective treatment for colorectal cancer (CRC) (1,2), and certain procedures, such as low anterior resection and intersphincteric resection for lower rectal cancer, require an ileostomy to reduce the risk of severe anastomotic leakage (3-5). High-output ileostomy (HOI) is often observed and is accompanied by electrolyte abnormalities and/or stoma complications (6-8).The aim of the present study was to determine the frequency and risk factors of HOI and to create a prediction model of HOI. Predicting HOI may be useful for perioperative treatment. Patients and methodsPatients and data sets. A total of 68 consecutive patients who underwent surgery for colorectal cancer with ileostomy at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan) between 2011 and 2016 were retrospectively analyzed. HOI was defined by a maximum output of >2,000 ml/day and high output (>1,000 ml/day) lasting for >3 days (Fig. 1). A total of 7 patients for whom detailed data of output were unavailable were excluded (Fig. 2). Based on a group of 50 patients who underwent surgery between 2011 and 2013, a decision tree was used to develop a prediction model for HOI. Clinicopathological factors, such as patient sex, age, body mass index, tumor stage, pr...

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Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer: a propensity score matching analysis of 1014 consecutive patients

Abstract: The rate of symptomatic AL was comparable following laparoscopic and open LAR in this large, multicenter, cohort study after PSM. Male gender was associated with an increased risk of symptomatic AL after laparoscopic LAR.

Cited by 55 publications

References 26 publications

Preventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratification

Preventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratification

Novel nomogram with microvascular density in the surgical margins can accurately predict the risk for anastomotic leakage after anterior resection for rectal cancer

Prediction model and treatment of high-output ileostomy in colorectal cancer surgery

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