Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

Abstract

Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

Delayed anastomotic leakage following laparoscopic intersphincteric resection for lower rectal cancer: report of four cases and literature review

“…There is a lack of understanding as to whether or not delayed AL is different from early AL. Reported risk factors for early AL following rectal surgery are low level of anastomosis, male gender, and the presence of intraoperative adverse events [ 6 – 8 ], which may correlate to the degree of surgical difficulty. In terms of the timeframe in which delayed AL develops, delayed AL does not seem to be attributable to technical factors, but rather to other predisposing factors.…”

“…Anastomotic leakage (AL) is one of the most dreadful postoperative complications of colorectal cancer because it can result in increased morbidity and mortality as well as poorer long-term prognosis. Reported incidence rates of colorectal AL vary between 3 and 20% [ 6 – 8 ]. Although most studies of AL have limited their investigation time to a period of postoperative 30 days, some studies have shown that AL can occur more than 30 days postoperatively [ 9 – 14 ].…”

Is the preservation of the left colic artery an ideal choice for colorectal cancer surgery? A meta-analysis

“…The reported postoperative occurrence risk is 2.2%-12% [47], despite the advancements in laparoscopic techniques and the well-accepted concept of total mesocolic excision. The blood supply and tension of the anastomosis are two major factors affecting the rate of anastomotic leakage [48]. In our opinion, for cancers located in the descending colon or the sigmoid colon, the ligation of the sigmoid artery and superior rectal artery would greatly compromise blood supply of the bowel distal to the anastomosis stoma.…”

Anastomotic leakage rate following modified double staple technique of anterior resection with vertical division of the rectum for rectal cancer surgery

“…They analyzed the tumor size and the recompression before stapler firing was risk factors for AL after laparoscopic LAR with DST anastomosis. He also reviewed preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis [11]. Multiple staple firing and diameter of circular stapler are intraoperative risk factors.…”