Brisinda G, Chiarello MM, Pepe G, Cariati M, Fico V, Mirco P, Bianchi V. Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors. World J Clin Cases 2022; 10(36): 13321-13336 [PMID: 36683625 DOI: 10.12998/wjcc.v10.i36.13321]
Corresponding Author of This Article
Giuseppe Brisinda, MD, Professor, Surgeon, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2022; 10(36): 13321-13336 Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13321
Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors
Giuseppe Brisinda, Maria Michela Chiarello, Gilda Pepe, Maria Cariati, Valeria Fico, Paolo Mirco, Valentina Bianchi
Giuseppe Brisinda, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Giuseppe Brisinda, Department of Surgery, Università Cattolica S Cuore, Rome 00168, Italy
Maria Michela Chiarello, Department of Surgery, Azienda Sanitaria Provinciale di Cosenza, Cosenza 87100, Italy
Gilda Pepe, Valeria Fico, Paolo Mirco, Valentina Bianchi, Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
Maria Cariati, Department of Surgery, Azienda Sanitaria Provinciale di Crotone, Crotone 88900, Italy
Author contributions: Brisinda G contributed to the writing-original draft; Brisinda G, Chiarello MM and Bianchi V contributed to the conceptualization, methodology and writing-reviewing and editing; Brisinda G, Pepe G, Cariati M, Fico V and Mirco P contributed to the data curation; Brisinda G and Fico V contributed to the formal analysis; Fico V and Mirco P contributed to the investigation; All the authors read and approved the final manuscript.
Institutional review board statement: The study involves the analysis of clinical data. For this reason, the approval of the Institutional Board of the Ethics Committee was not required. The study did not lead to changes in the diagnosis and treatment of the disease in the patients under analysis.
Informed consent statement: All patients were informed about the treatment modalities at the time they were observed. Regarding the study, this is a retrospective analysis of anonymous clinical data.
Conflict-of-interest statement: The authors have no financial or personal relationships that may inappropriately influence this work. No funding body had any involvement in the preparation or content of this manuscript or in decision to submit for publication.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giuseppe Brisinda, MD, Professor, Surgeon, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. gbrisin@tin.it
Received: October 13, 2022 Peer-review started: October 13, 2022 First decision: November 6, 2022 Revised: November 8, 2022 Accepted: December 5, 2022 Article in press: December 5, 2022 Published online: December 26, 2022 Processing time: 74 Days and 10.9 Hours
Abstract
BACKGROUND
Anastomotic leakage (AL) after restorative surgery for rectal cancer (RC) is associated with significant morbidity and mortality.
AIM
To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study.
METHODS
To identify risk factors for AL, a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated.
RESULTS
The incidence of AL was 10.4%, with a mean time interval of 6.2 ± 2.1 d. Overall mortality was 0.8%. Mortality was higher in patients with AL (4.9%) than in patients without leak (0.4%, P = 0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index < 40 points, tumor diameter and intraoperative blood loss were identified as risk factors for AL. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to AL in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube significantly did.
CONCLUSION
Clinical, surgical and pathological factors are associated with an increased risk of AL. It adversely affects the morbidity and mortality of RC patients.
Core Tip: Anastomotic leakage (AL) after rectal cancer surgery is associated with significant morbidity and mortality. A review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis in a 15-year period was performed. The overall incidence of AL was 10.4%. Mortality was higher in patients with AL than in patients without leak. Prognostic nutritional index < 40 points and intraoperative blood loss were identified as risk factors for AL. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler and level of vascular section were also correlated to AL in our patients.
