Risk factors causing structural sequelae after anastomotic leakage in mid to low rectal cancer

Table 1 Baseline characteristics of patients diagnosed with anastomosis leakage after resection of mid to low rectal cancer (n = 79)

	n (%)	Surgical method	n (%)
Age (yr), median	59
Gender		Conventional	3 (3.8)
Male	55 (69.6)	Laparoscopic	45 (57.0)
Female	24 (30.4)	Robotic	28 (35.4)
BMI (mean, kg/m2)	24.18	Conversion	3 (3.8)
ASA score		Anastomosis method
I	34 (43.0)	Hand-sewn	10 (12.8)
II	43 (54.4)	Stapling	68 (87.2)
III	2 (2.5)	Anastomosis type
Tumor stage		End-to-end	70 (88.6)
0/I	23 (29.1)	End-to-side	5 (6.3)
II	24 (30.4)	Colonic J-pouch	4 (5.1)
III	24 (30.4)	Neoadjuvant chemoradiotherapy	19 (24.1)
IV	8 (10.1)	Transfusion	13 (17.3)

Data are expressed as n (%), mean or median. BMI: Body mass index; ASA: American Society of Anesthesiologists.

Table 2 Univariate analysis of differences between the sequelae and no sequelae groups (n = 73) n (%)

				95%CI
	Sequelae1	No sequelae	OR	Lower	Upper	P value
Age, median (yr)	62	55.5				0.037
> 65	11 (37.9)	14 (31.8)	1.459	0.557	3.819	0.442
Gender
Male	21 (72.4)	30 (68.2)	1.148	0.411	3.212	0.792
BMI, mean	23.99	24.25				0.748
ASA score
I	11	20
II/III	18	24	1.259	0.487	3.255	0.635
Operation time, mean (min)	284.49	260.74				0.205
Ileostomy	21 (72.4)	20 (45.5)	3.412	1.254	9.290	0.016
LNM, mean	1.1	1.3				0.698
RLN, mean	22.1	23.6				0.681
Stage
0/I/II	22 (75.9)	22 (50.0)
III/IV	7 (24.1)	22 (50.0)	0.318	0.114	0.890	0.029
Tumor location, median (centimeters from AV)	5	5.5				0.144
Neoadjuvant chemoradiotherapy	9 (31.0)	8 (18.2)	2.137	0.715	6.393	0.174
Surgical method						0.080
Conventional	0	3 (6.9)
Laparoscopic	14 (48.3)	27 (61.4)
Robotic	13 (44.8)	14 (31.8)
Conversion	2 (6.9)	0
Anastomosis						0.726
Hand-sewn	3 (10.3)	6 (13.6)
Stapling	26 (89.7)	38 (86.4)
Anastomosis type						0.766
End-to-end	26 (89.7)	39 (88.6)
End-to-side	2 (6.9)	2 (4.5)
Colonic J-pouch	1 (3.4)	3 (6.9)
Mechanical bowel preparation
Yes	20 (69.0)	34 (77.3)
No	9 (31.0)	10 (22.7)	0.784	0.281	2.187	0.642
Initial AL management						0.512
Conservative	12 (41.4)	20 (45.5)
PAD	7 (24.1)	9 (20.5)
Diversion only	4 (13.8)	10 (22.7)
Primary repair + diversion	0	1 (2.3)
Surgical irrigation + drainage	6 (20.7)	4 (9.1)
Transfusion	8 (27.6)	4 (9.1)	3.810	1.027	14.137	0.046
Leakage (d)	5.7	4.2				0.054
Hospital stay (d)	48.9	20.9				0.001
Days to start diet (d)	6.3	5.7				0.665
Antibiotics use (d)	25.3	15.0				0.001
ICU transfer	3 (10.3)	3 (6.9)	1.212	0.251	5.852	0.811
Multi-organ failure	3 (10.3)	2 (4.3)	2.538	0.398	16.204	0.325
Postoperative ileus	5 (17.2)	4 (8.7)	2.197	0.536	8.935	0.276

¹Patients who had structural sequelae after leakage, includes patients with anastomosis fistula, sinus, or stricture. Data are expressed as n (%), mean or median. BMI: Body mass index; ASA: American Society of Anesthesiologists; LNM: Lymph node metastasis; RLN: Retrieved lymph nodes; AV: Anal verge; PAD: Percutaneous abscess drainage; AL: Anastomotic leakage; ICU: Intensive care unit; OR: Odds ratio.

Table 3 Univariate analysis of differences between the permanent stoma and no permanent stoma groups (n = 79) n (%)

				95%CI
	PS	No PS	OR	Lower	Upper	P value
Age, median (yr)	58	60				0.772
> 65	4 (28.6)	25 (38.5)	0.250	0.181	2.262	0.488
Gender
Male	10 (71.4)	45 (69.2)	1.111	0.311	3.971	0.871
BMI, mean	24.29	24.16				0.893
ASA score
I	8 (57.1)	26 (40.0)
II/III	6 (42.9)	39 (60.0)	0.500	0.155	1.609	0.245
Surgical time, mean (min)	274.79	269.63				0.827
Ileostomy	11 (78.6)	34 (52.3)	3.343	0.853	13.107	0.083
LNM, mean	2.21	1.06				0.299
RLN, mean	20.57	23.11				0.561
Stage
0/I/II	9 (64.3)	23 (58.5)
III/IV	5 (35.7)	23 (41.5)	0.782	0.236	2.594	0.688
Tumor location, median (centimeters from AV)	3	5				0.029
Neoadjuvant chemoradiotherapy	5 (35.7)	14 (21.5)	2.204	0.584	7.014	0.266
Surgical method						0.438
Conventional	0 (0)	3 (4.6)
Laparoscopic	10 (71.4)	35 (53.8)
Robotic	3 (21.4)	25 (38.5)
Conversion	1 (7.1)	2 (3.1)
Anastomosis						0.545
Hand-sewn	1 (7.7)	9 (13.8)
Stapling	12 (92.3)	56 (86.2)
Anastomosis type						0.129
End-to-end	12 (85.7)	58 (89.2)
End-to-side	2 (14.3)	3 (4.6)
Colonic J-pouch	0	4 (6.2)
Mechanical bowel preparation
Yes	5 (35.7)	17 (26.2)
No	9 (64.3)	48 (73.8)	0.638	0.187	2.171	0.471
Initial AL management						0.633
Conservative	4 (28.6)	29 (44.6)
PAD	4 (28.6)	13 (20.0)
Diversion only	2 (14.3)	12 (18.5)
Primary repair and diversion	0	1 (1.5)
Surgical irrigation and drainage	3 (21.4)	7 (10.8)
Re-anastomosis and diversion	0	2 (3.1)
Hartmann’s procedure	1 (7.1)	1 (1.5)
Transfusion	5 (35.7)	10 (15.4)	3.056	0.846	11.036	0.088
Leakage, mean (d)	5.0	4.7				0.768
Hospital stay, mean (d)	45.9	29.1				0.121
Days to start diet, mean (d)	7.5	5.8				0.427
Antibiotics use, mean (d)	26.8	17.5				0.018
ICU transfer	4 (28.6)	5 (7.7)	4.800	1.098	20.990	0.037
Multi-organ failure	3 (21.4)	3 (4.6)	5.636	1.005	31.602	0.049
Postoperative ileus	1 (7.1)	8 (12.3)	0.548	0.063	4.773	0.586

Data are expressed as n (%), mean or median. PS: Permanent stoma; BMI: Body mass index; ASA: American Society of Anesthesiologists; LNM: Lymph node metastasis; RLN: Retrieved lymph nodes; AV: Anal verge; AL: Anastomotic leakage; PAD: Percutaneous abscess drainage; ICU: Intensive care unit; OR: Odds ratio.

Table 4 Multivariate analysis of the sequelae and no sequelae groups including variables selected on univariate analysis

		95%CI
	OR	Lower	Upper	P value
Age	1.035	0.979	1.095	0.378
Ileostomy	6.741	1.069	13.372	0.017
Stage (III/IV)	0.292	0.079	1.077	0.064
Antibiotics use (d)	1.016	0.954	1.085	0.613
Hospital stay (d)	1.045	0.987	1.106	0.135
Transfusion	5.760	0.787	42.138	0.085

OR: Odds ratio.

Table 5 Multivariate analysis of the permanent stoma and no permanent stoma groups with factors selected on univariate analysis

		95%CI
	OR	Lower	Upper	P value
Tumor location	0.751	0.567	0.994	0.045
Antibiotic use	1.036	0.990	1.084	0.125
ICU transfer	4.184	0.277	63.162	0.301
Multi-organ failure	0.685	0.027	17.426	0.528

OR: Odds ratio; ICU: Intensive care unit.