Risk factors for anastomotic leakage after laparoscopic rectal resection

Abstract

Purpose: The anastomotic leakage rate after rectal resection has been reported to be approximately 2.5-21 percent, but most results were associated with open surgery. The aim of this study was to identify risk factors and their relationship to the experience of the surgeon for anastomotic leakage after laparoscopic rectal resection.

Methods: Between March 2003 and December 2008, 156 patients underwent a laparoscopic rectal resection without a diverting ileostomy. The patients' characteristics, the details of treatment, the intraoperative results, and the postoperative results were recorded prospectively. Univariate and multivariate analyses were applied to identify risk factors for anastomotic leakage.

Results: The majority of operations were performed for malignant disease (n = 150; 96.2%), and 96 patients (61.5%) were males. Conversion to open surgery occurred in 1 case (0.6%). The anastomotic leak rate was 10.3% (16/156), and there were no mortalities. In the univariate analysis, tumor location, anastomotic level, intraoperative events, and operation time were associated with increased anastomotic leakage rate. In the multivariate analysis, anastomotic level (odds ratio [OR], 6.855; 95% confidence interval [CI], 1.271 to 36.964) and operation time (OR, 8.115; 95% CI, 1.982 to 33.222) were significantly associated with anastomotic leakage.

Conclusion: The important risk factors for anastomotic leakage after laparoscopic rectal resection without a diverting ileostomy were low anastomosis and long operation time. An additional procedure, such as diverting stoma, may reduce the anastomotic leakage if it is selectively applied in cases with these risk factors.

Keywords: Anastomotic leakage; Laparoscopic surgery; Rectal resection; Risk factors.

Fig. 1

Success rate for a laparoscopic rectal resection without a diverting ileostomy as a function of the number of cases. The curves represent a cumulative sum (CUSUM) analysis for anastomotic leakage, calculated for target success rates of 85%, 88%, 90%, 92%, and 95% respectively. 'Failure' means an anastomotic leakage after a laparoscopic rectal resection without a diverting ileostomy. Upward slopes indicate that the rate of failure exceeds the acceptable failure rate whereas downward slopes indicate that the rate of failure falls within the acceptable rate range.