title: A'high tie'confers an increased risk of anastomotic leakage for lower rectal cancer surgery in patients treated with preoperative radiotherapy.
abstract: OBJECTIVE
  This study aimed at analyzing retrospectively the risk factors for anastomotic leakage for lower rectal cancer treated with preoperative radiotherapy.
  
  
  METHODS
  The subjects were 108 patients with T3 lower rectal cancer, who underwent curative resection following preoperative radiotherapy. All patients had a diverting stoma made. Univariate and multivariate analyses were conducted for the independent clinical variables.
  
  
  RESULTS
  Anastomotic leakage developed in 19 (17.6 %) patients. Univariate analysis of the risk factors for anastomotic leakage revealed that arterial ligation with a high tie (p = 0.001), undifferentiated tumor type (p = 0.002), a shorter distance from the anal verge (p = 0.086), and a longer hospital stay (p = 0.0002) were significant predictors of leakage. Multivariate analysis revealed that a high tie [hazard ratio 12.22 (95 % confidence interval 2.83-87.94); p = 0.0003], undifferentiated tumor type [91.15 (5.98-3128.03); p = 0.0008], and a long hospital stay [13.03 (2.86-104.93); p = 0.0004] were independently associated with anastomotic leakage.
  
  
  CONCLUSIONS
  Our data suggest that preoperative radiotherapy and a high tie for lower rectal cancer are independent risk factors for anastomotic leakage.
authors.affiliation: Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan, beppu-n@hyo-med.ac.jp.
authors.forename: Naohito
authors.initials: N
authors.lastname: Beppu
authors.forename: Nagahide
authors.initials: N
authors.lastname: Matsubara
authors.forename: Masashi
authors.initials: M
authors.lastname: Noda
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kimura
authors.forename: Naoki
authors.initials: N
authors.lastname: Yamanaka
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yanagi
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods*; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000209:etiology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008026:Ligation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D011300:Preoperative Care / Q000009:adverse effects*; D011878:Radiotherapy / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D054047:Surgical Stomas; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*