Risk factors for anastomotic leakage after laparoscopic intersphincteric resection for low-lying rectal cancer / 中华普通外科杂志

ABSTRACT

Objective To investigate the risk factors for anastomotic leakage (AL) after laparoscopic intersphincteric resection (Lap-ISR) for patients with low-lying rectal cancer.Methods This retrospective study was conducted in the Characteristic Medical Center of PLA Rocket Force from Jun 2011 to Nov 2018.151 patients undergoing Lap-ISR were enrolled for this study.Results All patients in this series had a defunctioning ileostomy.The overall leakage rate was 17.2％ (26/151),including peri-operative AL (n =20) and delayed AL (n =6).In accordance with the grading system of the International Study Group of Rectal Cancer,there were 24 patients (15.9％) with AL Grade B (requiring active therapeutic intervention) and two patients (1.3％) with AL Grade C (requiring re-laparotomy).Univariate analysis showed that BMI (≥ 25 kg/m2),tumor annularity (≥ 3/4) and operation time (≥ 240 min) were associated with AL (P ＜ 0.05).Multivariate analysis showed that operation time (≥ 240 min,OR =7.390,95％ CI2.483-21.988,P =0.000),tumor annularity (≥ 3/4,OR =6.233,95％ CI1.932-20.107,P=0.002) and higher BMI (≥ 25 kg/m2,OR=3.523,95％ CI1.275-9.738,P=0.015)were independently predictive of AL Conclusion Tumor annularity,operation time and higher BMI are independently associated with symptomatic AL after Lap-ISR.