title: Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group.
abstract: OBJECTIVE
  To assess the risk factors for clinical anastomotic leakage (AL) in patients undergoing laparoscopic surgery for rectal cancer.
  
  
  BACKGROUND
  Little data are available about risk factors for AL after laparoscopic rectal cancer resection.
  
  
  METHODS
  This was a retrospective analysis of 1609 patients with rectal cancer who had undergone laparoscopic surgery for rectal cancer with sphincter preservation. Clinical data related to AL were collected from 11 institutions. Univariate and multivariate analyses were performed to determine the risk factors for AL.
  
  
  RESULTS
  AL was noted in 101 (6.3%) of the patients. The leakage rate ranged from 2.0% to 10.3% for each hospital (P = 0.04). In patients without protective stomas (n = 1187), male sex [hazard ratio (HR), 3.468], advanced tumor stage (HR, 2.520), lower tumor level (HR, 2.418), preoperative chemoradiation (HR, 6.284), perioperative transfusion (HR, 10.705), and multiple firings of the linear stapler (HR, 6.181) were significantly associated with AL. Our theoretical model suggested that the HR for patients with 2 risk factors was significantly higher than that the HR for patients with no or only 1 risk factor.
  
  
  CONCLUSIONS
  Male sex, low anastomosis, preoperative chemoradiation, advanced tumor stage, perioperative bleeding, and multiple firings of the linear stapler increased the risk of AL after laparoscopic surgery for rectal cancer. A diverting stoma might be mandatory in patients with 2 or more of the risk factors identified in this analysis.
authors: Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea. kyuschoi@mail.knu.ac.kr
authors: Jun Seok
authors: JS
authors: Park
authors: Gyu-Seog
authors: GS
authors: Choi
authors: Seon Hahn
authors: SH
authors: Kim
authors: Hyeong Rok
authors: HR
authors: Kim
authors: Nam Kyu
authors: NK
authors: Kim
authors: Kang Young
authors: KY
authors: Lee
authors: Sung Bum
authors: SB
authors: Kang
authors: Ji Yeon
authors: JY
authors: Kim
authors: Kil Yeon
authors: KY
authors: Lee
authors: Byung Chun
authors: BC
authors: Kim
authors: Byung Noe
authors: BN
authors: Bae
authors: Gyung Mo
authors: GM
authors: Son
authors: Sun Il
authors: SI
authors: Lee
authors: Hyun
authors: H
authors: Kang
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D005260:Female; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors