Predictive risk factors for anastomotic leakage after anterior resection of rectal cancer in elderly patients over 80 years old: an analysis of 288 consecutive patients

Sicheng Zhou, Haitao Zhou, Zhaoxu Zheng, Jianwei Liang, Zhixiang Zhou, Xishan Wang, Sicheng Zhou, Haitao Zhou, Zhaoxu Zheng, Jianwei Liang, Zhixiang Zhou, Xishan Wang

Abstract

Background: Anastomotic leakage (AL) is a common complication after anterior resection of rectal cancer. Few studies have been conducted to determine whether the traditional predictors of AL can be applied to elderly patients (age ≥ 80) undergoing anterior resection (AR) or low anterior resection (LAR) of rectal cancer. This study was designed to explore the predictive factors for AL after anterior resection of rectal cancer in patients over 80 years old.

Methods: From January 2007 to May 2019, consecutive elderly (age ≥ 80) rectal cancer patients undergoing AR or LAR at our institution were systematically reviewed. The general information, perioperative outcomes, and comorbidities were collected.

Results: A total of 288 consecutive patients were included in this study. The average age was 82.8 ± 2.4 years, and 30 (10.4%) patients developed AL. The univariate analyses showed that neoadjuvant therapy (50.0% vs. 27.9%, P = 0.013), the number of stapler firings ≥ 3 (60.0% vs. 36.0%, P = 0.011), and coronary heart disease (CHD) (46.7% vs. 17.8%, P < 0.001) were associated with an increased incidence of AL. The multivariate analysis showed that the number of stapler firings ≥ 3 (OR = 4.77, 95% CI = 1.33-15.21, P = 0.035) and CHD (OR = 8.33, 95% CI = 1.94-13.05, P = 0.003) were independent risk factors for AL.

Conclusion: The number of stapler firings ≥ 3 and CHD were independent risk factors for AL in elderly patients (age ≥ 80) with rectal cancer. A temporary ileostomy or the Hartmann procedure is recommended for patients with CHD, male patients, patients considered to be obese, and patients with a lower tumor location, which may increase the number of stapler firings. Certainly, we recommend that the number of stapler firings should be minimized to alleviate the economic and physical burden of patients.

Keywords: Anastomotic leakage; Comorbidity; Elderly patient; Rectal cancer; Risk factor.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Fukuoka H, Afshari NA. The impact of age-related cataract on measures of frailty in an aging global population. Curr Opin Ophthalmol. 2017;28(1):93–97. doi: 10.1097/ICU.0000000000000338.
    1. Ferlay J, Soeriomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–E386. doi: 10.1002/ijc.29210.
    1. Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890–899. doi: 10.1097/SLA.0b013e3182128929.
    1. Hain E, Maggiori L, Manceau G, et al. Persistent asymptomatic anastomotic leakage after laparoscopic sphincter-saving surgery for rectal cancer: can diverting stoma be reversed safely at 6 months? Dis Colon Rectum. 2016;59(5):369–376. doi: 10.1097/DCR.0000000000000568.
    1. Buchs NC, Gervaz P, Secic M, et al. Incidence, consequence and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2008;23(3):265–270. doi: 10.1007/s00384-007-0399-3.
    1. Alves A, Panis Y, Trancart D, et al. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26(4):499–502. doi: 10.1007/s00268-001-0256-4.
    1. Boyce SA, Harris C, Stevenson A, et al. Management of low colorectal anastomotic leakage in the laparoscopic era: more than a decade of experience. Dis Colon Rectum. 2017;60(8):807–814. doi: 10.1097/DCR.0000000000000822.
    1. Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum. 2005;48(5):1021–1026. doi: 10.1007/s10350-004-0869-4.
    1. Dauser B, Braunschmid T, Ghaffari S, et al. Anastomotic leakage after low anterior resection for rectal cancer: comparison of stapled versus compression anastomosis. Langenbecks Arch Surg. 2013;398(7):957–964. doi: 10.1007/s00423-013-1103-4.
    1. Nachiappan S, Askari A, Malietzis G, et al. The impact of anastomotic leakage and its treatment on cancer recurrence and survival following elective colorectal cancer resection. World J Surg. 2015;39:1052–1058. doi: 10.1007/s00268-014-2887-2.
    1. Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147(3):339–351. doi: 10.1016/j.surg.2009.10.012.
    1. Rutkowski A, Olesiński T, Zając L, et al. The risk of anastomotic leakage after anterior resection: retrospective analysis of 501 rectal cancer patients operated without protective stoma. Minerva Chir. 2017;72(6):491–498.
    1. Tortorelli AP, Alfieri S, Sanchez AM, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg. 2015;81(1):41–47.
    1. Shiomi A, Ito M, Maeda K, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1014 consecutive patients. J Am Coll Surg. 2015;220(2):186–194. doi: 10.1016/j.jamcollsurg.2014.10.017.
    1. Zheng Hongtu, Wu Zhenyu, Wu Yuchen, Mo Shanjing, Dai Weixing, Liu Fangqi, Xu Ye, Cai Sanjun. Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer. International Journal of Colorectal Disease. 2018;34(2):319–328. doi: 10.1007/s00384-018-3199-z.
    1. Ito M, Sugito M, Kobayashi A, et al. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008;23(7):703–707. doi: 10.1007/s00384-008-0470-8.
    1. Kim JS, Cho SY, Min BS, et al. Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique. J Am Coll Surg. 2009;209(6):694–701. doi: 10.1016/j.jamcollsurg.2009.09.021.
    1. Park JS, Choi GS, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg. 2013;257(4):665–671. doi: 10.1097/SLA.0b013e31827b8ed9.
    1. Kawada K, Hasegawa S, Hida K, et al. Risk factors fornanastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc. 2014;28(10):2988–2995. doi: 10.1007/s00464-014-3564-0.
    1. Shogan BD, Carlisle EM, Alverdy JC, et al. Do we really know why colorectal anastomoses leak? J Gastrointest Surg. 2013;17(9):1698–1707. doi: 10.1007/s11605-013-2227-0.
    1. Fawcett A, Shembekar M, Church JS, et al. Smoking, hypertension, and colonic anastomotic healing; a combined clinical and histopathological study. Gut. 1996;38(5):714–718. doi: 10.1136/gut.38.5.714.
    1. Vignali A, Gianotti L, Braga M, et al. Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum. 2000;43(1):76–82. doi: 10.1007/BF02237248.
    1. Galloway JM. The epidemiology of atherosclerosis and its risk factors among native Americans. Curr Diab Rep. 2002;2(3):274–281. doi: 10.1007/s11892-002-0095-1.
    1. Kruschewski M, Rieger H, Pohlen U, et al. Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Color Dis. 2007;22(8):919–927. doi: 10.1007/s00384-006-0260-0.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe