Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer

Abstract

Objective : Anastomotic leakage (AL) is one of the most devastating complications of rectal cancer surgery. Not only does AL result in reduced quality of life, extended hospitalization and impaired defecatory function, it also has a high local recurrence rate. In this study, we investigated risk factors for AL as it may help to decrease its occurrence and improve patient outcomes. Methods : This study was a retrospective, singleinstitution study of rectal cancer patients who underwent elective low anterior resection between April 2002 and February 2018 at Fukushima Medical University Hospital. Patients were divided into two groups according to the presence of AL. Patient-, tumor-, and surgeryrelated variables were examined using univariate and multivariate analyses. Results : One hundred sixtyone patients, average age 63.5±11.5 years, were enrolled in the study. The overall AL rate was 6.8% (11/161). In the univariate analysis, modified Glasgow Prognostic Score (mGPS)=2 (p=0.003), use of multiple staplers (≥3 firings) for rectal transection (p=0.001) and intraoperative bleeding (≥250 g) were significantly associated with AL incidence. Multivariate analysis identified that mGPS = 2 (odds ratio [OR] : 19.6, 95% confidence interval [CI] : 2.96-125.00, p=0.002) and multiple firings (OR : 18.19, CI : 2.31-111.11, p=0.002) were independent risk factors for AL. Conclusion : Higher mGPS score and multiple firings were independent risk factors for AL.

Preoperative C-reactive Protein-to-albumin Ratio Predicts Anastomotic Leakage After Esophagectomy for Thoracic Esophageal Cancer: a Single-center Retrospective Cohort Study

“…Several recent studies have reported the utility of various in ammation-based and/or nutritional markers as predictors of postoperative complications and poor prognosis in esophageal cancer, such as the Onodera's prognostic nutritional index (PNI), CRP-to-albumin ratio (CAR) and modi ed Glasgow prognostic score (mGPS), which are calculated based on laboratory data including serum albumin or CRP [6][7][8]. Some studies have reported preoperative PNI, CAR and mGPS as predictors for AL after gastrointestinal cancer surgery [9][10][11]. However, no studies appear to have examined the association between preoperative in ammationbased and/or nutritional markers and AL after esophageal cancer surgery.…”

Preoperative C-reactive protein to albumin ratio predicts anastomotic leakage after esophagectomy for thoracic esophageal cancer: a single-center retrospective cohort study

“…Several recent studies have reported the utility of various inflammation-based and/or nutritional markers as predictors of postoperative complications and poor prognosis in esophageal cancer, such as the Onodera’s prognostic nutritional index (PNI), CRP-to-albumin ratio (CAR) and modified Glasgow prognostic score (mGPS), which are calculated based on laboratory data including serum albumin or CRP [ 6 – 8 ]. Some studies have reported preoperative PNI, CAR and mGPS as predictors for AL after gastrointestinal cancer surgery [ 9 – 11 ]. However, no studies appear to have examined the association between preoperative inflammation-based and/or nutritional markers and AL after esophageal cancer surgery.…”

A Novel Technique for Low Rectal Cancer: Pushing the Anus in Laparoscopic Radical Resection

“…Three or more cartridges of the linear stapler are a risk factor for anastomotic leakage. [23][24][25] In addition, recent systematic evaluation has shown that using two cartridges also have a higher incidence of anastomotic leakage than using one during laparoscopic rectal cancer resection. 26 In all of our patients with anastomotic leaks, the number of stapler cartridges used was more than two, which may have contributed to a higher incidence of anastomotic leaks in the conventional surgery group.…”