title: Risk factors for anastomotic leakage after laparoscopic surgery with the double stapling technique for stage 0/I rectal carcinoma: a subgroup analysis of a multicenter, single-arm phase II trial.
abstract: OBJECTIVE
  The aim of this study was to determine the risk factors for anastomotic leakage after laparoscopic rectal surgery.
  
  
  METHODS
  We conducted a prospective trial involving 395 patients with stage 0/I rectal carcinoma who underwent laparoscopic low anterior resection using a double stapling technique. Data concerning variables related to patient background, tumors and surgical factors were evaluated. The outcomes with respect to anastomotic leakage were recorded, and univariate and multivariate analyses were performed to identify relevant risk factors.
  
  
  RESULTS
  The overall anastomotic leakage rate was 8.4%. A univariate analysis showed male gender (P = 0.006) and preoperative blood sugar level (P = 0.0034) to be significantly associated with anastomotic leakage. The variables of gender, preoperative blood sugar level, American Society of Anesthesiologists (ASA) classification (P = 0.15), transanal decompression tube (P = 0.06) and number of stapler cartridges used for rectal transection (P = 0.18) were selected for the multivariate analysis because of their P values being <0.2. The multivariate analysis identified male gender (odds ratio 4.12, P = 0.006) and the absence of a transanal decompression tube (odds ratio 3.11, P = 0.0484) as independent risk factors predicting anastomotic leakage.
  
  
  CONCLUSIONS
  Male gender and the absence of a transanal decompression tube appeared to be independent risk factors for anastomotic leakage. Insertion of a transanal decompression tube may help prevent anastomotic leakage after low anterior resection, particularly in male patients.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Cancer Center, Osaka Medical College Hospital, Osaka, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Okuda
authors.affiliation: Division of Gastroenterological Surgery, Hiratsuka City Hospital, 19-1-1, Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan. miyamamo@jcom.home.ne.jp.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Colorectal Surgery Division, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Gastroenterological Surgery, St. Marianna University Yokohama West Hospital, Kanagawa, Japan.
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Kokuba
authors.affiliation: Innovative Clinical Research Center, Kanazawa University Hospital, Ishikawa, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yoshimura
authors.affiliation: Department of Surgery, Kitasato University Hospital, Kanagawa, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007440:Intubation; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D012737:Sex Factors; D017792:Surgical Stapling / Q000379:methods*
keywords: Anastomotic leakage; Laparoscopic surgery; Multicenter study; Rectal carcinoma; Transanal decompression tube