Clinical manifestations and risk factors of anastomotic leakage after low anterior resection for rectal cancer.
BACKGROUND
Anastomotic leakage is a common complication that can be associated with catastrophic consequences. However, the risk factors and incidence of anastomotic leakage vary considerably among clinical studies because of the lack of a standardized definition, clinical course and appropriate treatment options. The aim of this study was to identify and classify the clinical manifestations and treatment of anastomotic leakage and analyse the possible risk factors after low anterior resection.


METHODS
From January 2009 to June 2010, 632 patients underwent low anterior resection for primary colorectal cancer at Samsung Medical Center. Patients with only one colorectal anastomosis were included from this prospectively collected medical database.


RESULTS
The overall leakage rate was 6.0% (n = 38). In cases of generalized leakage, the patients that selected surgical management, regardless of having protective enterostomy and time of occurrence, had better outcomes. Protective enterostomy did not have a preventive effect and was not associated with a lower rate of anastomotic leakage. However, protective enterostomy confined the inflammation to only the pelvic cavity (P = 0.045) and no surgical intervention was initially needed. Male gender (P = 0.021, relative risk (RR) = 2.680, 95% confidence interval (CI) = 1.164-6.171) and side-to-end/J pouch-to-end anastomosis (P = 0.012, RR = 2.696, 95% CI = 1.249-5.818) were significant risk factors that affected anastomotic leakage.


CONCLUSIONS
Surgical management is the best choice for generalized leakage. A protective enterostomy diminished the occurrence of generalized leakage and consequent surgical management; therefore, fragile patients at high risk for anastomotic leakage are recommended to undergo protective enterostomy.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jung-A
JA
Yun
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.|Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.|Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.
Yong Beom
YB
Cho
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Yoon Ah
YA
Park
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jung Wook
JW
Huh
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Seong Hyeon
SH
Yun
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Hee Cheol
HC
Kim
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.|Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.
Woo Yong
WY
Lee
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ho-Kyung
HK
Chun
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004766:Enterostomy / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D054047:Surgical Stomas; D016896:Treatment Outcome
anastomotic leakage; clinical outcome; colorectal cancer