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Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

  • Yang, Liu (Colorectal Cancer Center) ;
  • Huang, Xin-En (Department of Chemotherapy, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research) ;
  • Zhou, Jian-Nong (Colorectal Cancer Center)
  • Published : 2013.07.30

Abstract

Purpose: To investigate the risk factors for anastomotic leakage (AL) after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Between January 2004 and December 2011, 753 consecutive patients in Jiangsu Cancer Hospital and Research Institute diagnosed with rectal cancer and undergoing anterior resection with a double stapling technique were recruited. All patients experienced a total mesorectal excision (TME) operation. Additionally, decrease of postoperative tumor supplied group of factors (TSGF), which have not been reported before, was proposed as a new indicator for AL. Univariate and multivariate analysis were performed to determine risk factors for AL. Results: AL was detected in 57 (7.6%) of 753 patients with rectal cancer. The diagnosis of anastomotic leakage was confirmed between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate analysis and multivariate analysis, age (p<0.001), gender (p=0.002), level of anastomosis (p<0.001), preoperative body mass index (BMI) (p=0.001) and reduction of TSGF in 5th POD was less than 10 ${\mu}/ml$ (p<0.001) were selected as 5 independent risk factors for AL. It was also indicated that a temporary defunctioning transverse ileostomy (p=0.04) would decrease the occurrence of AL. Conclusion: AL after anterior resection for rectal carcinoma is related to elderly status, low level site of the tumor (below the peritoneal reflection), being male, preoperative BMI and the decrease of TSGF in $5^{th}$ POD is less than 10 ${\mu}/ml$. Preventive ileostomy is advisable after TME for low rectal tumors to prevent AL.

Keywords

Rectal cancer;anastomotic leakage;tumor supplied group of factors;anterior resection

References

  1. Li CG, Huang XE, Li Y, et al (2011). Clinical observations on safety and efficacy of OxyContin administered by rectal route in treating cancer related pain. Asian Pac J Cancer Prev, 12, 2477-8.
  2. Li CG, Huang XE, Li Y, et al (2011). Phase II trial of irinotecan plus nedaplatin (INP) in treating patients with extensive stage small cell lung cancer. Asian Pac J Cancer Prev, 12, 487-90.
  3. Li CG, Huang XE, Xu L, et al (2012). Clinical application of serum tumor associated material (TAM) from non-small cell lung cancer patients. Asian Pac J Cancer Prev, 13, 301-4. https://doi.org/10.7314/APJCP.2012.13.1.301
  4. Li Y, Yan PW, Huang XE, et al (2011). MDR1 gene C3435T polymorphism is associated with clinical outcomes in gastric cancer patients treated with postoperative adjuvant chemotherapy. Asian Pac J Cancer Prev, 12, 2405-9.
  5. Lin JK, Yueh TC, Chang SC, et al (2011). The influence of fecal diversion and anastomotic leakage on survival after resection ofrectal cancer. J Gastrointest Surg, 15, 2251-61. https://doi.org/10.1007/s11605-011-1721-5
  6. Lipska MA, Bissett IP, Parry BR, et al (2006). Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg, 76, 579-85. https://doi.org/10.1111/j.1445-2197.2006.03780.x
  7. Liu J, Huang XE, Tian GY, et al (2013). Phase II Study on Safety and Efficacy of Yadanzi (Javanica oil emulsion injection) Combined with Chemotherapy for Patients with Gastric Cancer. Asian Pac J Cancer Prev, 14, 2009-12. https://doi.org/10.7314/APJCP.2013.14.3.2009
  8. Liu W, Li SY, Huang XE, et al (2012). Inhibition of tumor growth in vitro by a combination of extracts from rosa roxburghii tratt and fagopyrum cymosum. Asian Pac J Cancer Prev, 13, 2409-14. https://doi.org/10.7314/APJCP.2012.13.5.2409
  9. Liu YC, Zhou SB, Gao F, (2013). Phase II study on breast conservative surgery plus chemo- and radiotherapy in treating Chinese patients with early staged breast cancer. Asian Pac J Cancer Prev, 14, 3747-50. https://doi.org/10.7314/APJCP.2013.14.6.3747
  10. Liu YC, Zhou SB, Gao F, et al (2013). Chemotherapy and late course three dimensional conformal radiotherapy for treatment of patients with stage III non- small cell lung cancer. Asian Pac J Cancer Prev, 14, 2663-5. https://doi.org/10.7314/APJCP.2013.14.4.2663
  11. Lu YY, Huang XE, Xu L, et al (2013). Potential predictors of sensitivity to pemetrexed as first-line chemotherapy for patients with advanced non-squamous NSCLCs. Asian Pac J Cancer Prev, 14, 2005-8. https://doi.org/10.7314/APJCP.2013.14.3.2005
  12. Markiewicz M, Asano Y, Znoyko S, et al (2007). Distinct effects of gonadectomy in male and female mice on collagen fibrillogenesis in the skin. J Dermatol Sci, 47, 217-26. https://doi.org/10.1016/j.jdermsci.2007.05.008
  13. Marusch F, Koch A, Schmidt U et al (2002). Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation. Langenbecks Arch Surg, 387, 94-100. https://doi.org/10.1007/s00423-002-0298-6
  14. Marusch F, Koch A, Schmidt U et al (2002). Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum, 45, 1164-71. https://doi.org/10.1007/s10350-004-6384-9
  15. Mileski WJ, Joehl RJ, Rege RV, et al (1988). Treatment of anastomotic leakage following low anterior resection. Arch Surg, 123, 968-71. https://doi.org/10.1001/archsurg.1988.01400320054011
  16. Eriksen MT, Wibe A, Norstein J, et al (2005). Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis, 7, 51-7. https://doi.org/10.1111/j.1463-1318.2004.00700.x
  17. Fazio VW, Zutshi M, Remzi FH, et al (2007). A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers. Ann Surg, 246, 481-90. https://doi.org/10.1097/SLA.0b013e3181485617
  18. Gao LL, Huang XE, Zhang Q, et al (2011). A Cisplatin and vinorelbine (NP) regimen as a postoperative adjuvant chemotherapy for completely resected breast cancers in China: final results of a phase II clinical trial. Asian Pac J Cancer Prev, 12, 77-80.
  19. Gastinger I, Marusch F, Steinert R et al (2005). Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg, 92, 1137-42. https://doi.org/10.1002/bjs.5045
  20. Gong P, Huang XE, Chen CY, et al (2012). Comparison on complications of peripherally inserted central catheters by ultrasound guide or conventional method in cancer patients. Asian Pac J Cancer Prev, 13, 1873-5. https://doi.org/10.7314/APJCP.2012.13.5.1873
  21. Gormsen LC, H st C, Hjerrild BE, et al (2012). Estradiol acutely inhibits whole body lipid oxidation and attenuates lipolysis in subcutaneous adiposetissue: a randomized, placebo-controlled study in postmenopausal women. Eur J Endocrinol, 67, 543-651.
  22. Gu M, Li SY, Huang XE, et al (2013). A phase II study on continuous infusional paclitaxel and 5-Fu as first-line chemotherapy for patients with advanced esophageal cancer. Asian Pac J Cancer Prev, 13, 5587-91.
  23. Huang XE, Li CG, Li Y, et al (2011). Weekly TP regimen as a postoperative adjuvant chemotherapy for completely resected breast cancer in China: final result of a phase II trial. Asian Pac J Cancer Prev, 12, 2797-800.
  24. Huang XE, Wei GL, Huo JG, et al (2013). Intrapleural or intraperitoneal lobaplatin for treatment of patients with malignant pleural effusion or ascites. Asian Pac J Cancer Prev, 14, 2611-4. https://doi.org/10.7314/APJCP.2013.14.4.2611
  25. Jiang Y, Huang XE, Yan PW, et al (2010). Validation of treatment efficacy of a computer-assisted program for breast cancer patients receiving postoperative adjuvant chemotherapy. Asian Pac J Cancer Prev, 11, 1059-62.
  26. Kasperk R, Philipps B, Vahrmeyer M, et al (2000). Risk factors for anastomosis dehiscence after very deep colorectal and coloanal anastomosis. Chirurg, 71, 1365-9. https://doi.org/10.1007/s001040051227
  27. Kumar A, Daga R, Vijayaragavan P, et al (2011). Anterior resection for rectal carcinoma - risk factors for anastomotic leaks and strictures. World J Gastroenterol, 21, 1475-9.
  28. Law WL, Choi HK, Lee YM, et al (2007). Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg, 11, 8-15. https://doi.org/10.1007/s11605-006-0049-z
  29. Lee WS, Yun SH, Roh YN, et al (2008). Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg, 32, 1124-9. https://doi.org/10.1007/s00268-007-9451-2
  30. Agren MS, Andersen TL, Mirastschijski U et al (2006). Action of matrix metalloproteinases at restricted sites in colon anastomosis repair: an immunohistochemical and biochemical study. Surgery, 140, 72-82. https://doi.org/10.1016/j.surg.2005.12.013
  31. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. Ca Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  32. Aznal SS, Meng FG, Nalliah S, et al (2012). Biochemical evaluation of the supporting structure of pelvic organs in selected numbers of premenopausal and postmenopausal Malaysian women. Indian J Pathol Microbiol, 5, 450-5.
  33. Bellows CF, Webber LS, Albo D, et al (2009). Early predictors of anastomotic leaks after colectomy. Tech Coloproctol, 13, 41-7. https://doi.org/10.1007/s10151-009-0457-7
  34. Bennis M, Parc Y, Lefevre JH, et al (2012). Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients. Ann Surg, 255, 504-10. https://doi.org/10.1097/SLA.0b013e31824485c4
  35. Bertelsen CA, Andreasen AH, J rgensen T, et al (2010). Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis, 12, 37-43.
  36. B nger S, Laubert T, Roblick UJ, et al (2011). Serum biomarkers for improved diagnostic of pancreatic cancer: a current overview. J Cancer Res Clin Oncol, 137, 375-89. https://doi.org/10.1007/s00432-010-0965-x
  37. Chen G, Shen ZL, Wang L, et al (2013). Hsa-miR-181a-5p Expression and Effects on Cell Proliferation in Gastric Cancer. Asian Pac J Cancer Prev, 14, 3871-5. https://doi.org/10.7314/APJCP.2013.14.6.3871
  38. Dai XZ, Yin HT, Sun LF, et al (2013). Potential therapeutic efficacy of curcumin in liver cancer. Asian Pac J Cancer Prev, 14, 3855-9. https://doi.org/10.7314/APJCP.2013.14.6.3855
  39. Deng B, Tan QY, Fan XQ, et al (2011). Clinical value of assaying tumor supplied group of factor/tumor specific growth factor in patients with solitary pulmonary nodule. Clin Lung Cancer, 12, 192-6. https://doi.org/10.1016/j.cllc.2011.03.017
  40. Deng QQ, Huang XE, Ye LH, et al (2013). Phase II trial of Loubo (Lobaplatin) and pemetrexed for patients with metastatic breast cancer not responding to anthracycline or taxanes. Asian Pac J Cancer Prev, 14, 413-7. https://doi.org/10.7314/APJCP.2013.14.1.413
  41. Paun BC, Cassie S, MacLean AR, et al (2010). Postoperative complications following surgery for rectal cancer. Ann Surg, 251, 807-18. https://doi.org/10.1097/SLA.0b013e3181dae4ed
  42. Peeters KC, Tollenaar RA, Marijnen CA et al (2005). Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg, 92, 211-6. https://doi.org/10.1002/bjs.4806
  43. Riss S, Stremitzer S, Riss K, et al (2011). Pelvic organ function and quality of life after anastomotic leakage following rectal cancer surgery. Wien Klin Wochenschr, 123, 53-7. https://doi.org/10.1007/s00508-010-1514-y
  44. Shu J, Li CG, Liu YC, et al (2012). Comparison of serum tumor associated material (TAM) with conventional biomarkers in cancer patients. Asian Pac J Cancer Prev, 13, 2399-403. https://doi.org/10.7314/APJCP.2012.13.5.2399
  45. Sorensen LT, Hemmingsen U, Kallehave F et al (2005). Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg, 241, 654-8. https://doi.org/10.1097/01.sla.0000157131.84130.12
  46. Sun MQ, Meng AF, Huang XE, et al (2013). Comparison of psychological influence on breast cancer patients between breast-conserving surgery and modified radical mastectomy. Asian Pac J Cancer Prev, 14, 149-52. https://doi.org/10.7314/APJCP.2013.14.1.149
  47. Tjandra JJ, Kilkenny JW, Buie WD, et al (2005). Standards practice task force; American society of colon and rectal surgeons. Practice parameters for the management of rectal cancer (revised). Dis Colon Rectum, 48, 411-23. https://doi.org/10.1007/s10350-004-0937-9
  48. Veenhof AA, Kropman RH, Engel AF, et al (2007). Preoperative radiation therapy for locally advanced rectal cancer: a comparison between two different time intervals to surgery. Int J Colorectal Dis, 22, 507-13. https://doi.org/10.1007/s00384-006-0195-5
  49. Wang L, Gu J (2010). Risk factors for symptomatic anastomotic leakage after low anterior resection for rectal cancer with 30 Gy/10 f/2 w preoperative radiotherapy. World J Surg, 34, 1080-5. https://doi.org/10.1007/s00268-010-0449-9
  50. Wong NY, Eu KW (2005). A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum, 48, 2076-9. https://doi.org/10.1007/s10350-005-0146-1
  51. Wu XY, Huang XE, You SX, et al (2013). Phase II study of pemetrexed as second or third line combined chemotherapy in patients with colorectal cancer. Asian Pac J Cancer Prev, 14, 2019-22. https://doi.org/10.7314/APJCP.2013.14.3.2019
  52. Xu HX, Huang XE, Li Y, et al (2011). A clinical study on safety and efficacy of Aidi injection combined with chemotherapy. Asian Pac J Cancer Prev, 12, 2233-6.
  53. Xu HX, Huang XE, Qian ZY, et al (2011). Clinical observation of Endostar combined with chemotherapy in advanced colorectal cancer patients. Asian Pac J Cancer Prev, 12, 3087-90.
  54. Xu JW, Li CG, Huang XE, et al (2011). Ubenimex capsule improves general performance and chemotherapy related toxicity in advanced gastric cancer cases. Asian Pac J Cancer Prev, 12, 985-7.
  55. Xu T, Xu ZC, Zou Q, Yu B, Huang XE (2012).P53 Arg72Pro polymorphism and bladder cancer risk--meta-analysis evidence for a link in Asians but not Caucasians. Asian Pac J Cancer Prev, 13, 2349-54. https://doi.org/10.7314/APJCP.2012.13.5.2349
  56. Xu X, Wang L, Xu HQ, et al (2013). Clinical Comparison between Paclitaxel Liposome (Lipusu ) and Paclitaxel for Treatment of Patients with Metastatic Gastric Cancer. Asian Pac J Cancer Prev, 14, 2591-4. https://doi.org/10.7314/APJCP.2013.14.4.2591
  57. Yamamoto S, Fujita S, Akasu T, et al (2012). Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using astapling technique. Surg Laparosc Endosc Percutan Tech, 22, 239-43. https://doi.org/10.1097/SLE.0b013e31824fbb56
  58. Yan PW, Huang XE, Jiang Y, et al (2010). A clinical comparison on safety and efficacy of Paclitaxel/Epirubicin (NE) with Fluorouracil/Epirubicin/Cyclophosphamide (FEC) as postoperative adjuvant chemotherapy in breast cancer. Asian Pac J Cancer Prev, 11, 1115-8.
  59. Yan PW, Huang XE, Yan F, et al (2011). Influence of MDR1 gene codon 3435 polymorphisms on outcome of platinum-based chemotherapy for advanced non small cell lung cancer. Asian Pac J Cancer Prev, 12, 2291-4.
  60. Yang J, Wang D (2007). Clinical value of tumor-associated growth factor detection in the diagnosis of colorectal carcinoma. Nan Fang Yi Ke Da Xue Xue Bao, 27, 1577-9.
  61. Yang WB, Zhang JW, Zhao YG, et al (2009). Discussion of relation between serum TSGF and prognosis of colon cancer. Xian Dai Yi Yao Wei Sheng, 25, 641-2.
  62. Yin HT, Tian QZ, Guan L (2013). In vitro and in vivo evaluation of the antitumor efficiency of resveratrol against lung cancer. Asian Pac J Cancer Prev, 14, 1703-6. https://doi.org/10.7314/APJCP.2013.14.3.1703
  63. Yin HT, Zhang DG, Wu XL (2013). In vivo evaluation of curcumin-loaded nanoparticles in a A549 xenograft mice model. Asian Pac J Cancer Prev, 14, 409-12. https://doi.org/10.7314/APJCP.2013.14.1.409
  64. Yu DS, Huang XE, Zhou JN, et al (2012). A Comparative study on the value of anal preserving surgery for aged people with low rectal carcinoma in Jiangsu, China. Asian Pac J Cancer Prev, 13, 2339-40. https://doi.org/10.7314/APJCP.2012.13.5.2339
  65. Zhan YP, Huang XE, Cao J (2012). Clinical safety and efficacy of Kanglaite (Coix Seed Oil) injection combined with chemotherapy in treating patients with gastric cancer. Asian Pac J Cancer Prev, 13, 5319-21. https://doi.org/10.7314/APJCP.2012.13.10.5319
  66. Zhan YP, Huang XE, Cao J (2012). Clinical study on safety and efficacy of Qinin (cantharidin sodium) injection combined with chemotherapy in treating patients with gastric cancer. Asian Pac J Cancer Prev, 13, 4773-6. https://doi.org/10.7314/APJCP.2012.13.9.4773
  67. Zhang LQ, Huang XE, Wang J (2011). The cyclin D1 G870A polymorphism and colorectal cancer susceptibility: a metaanalysis of 20 populations. Asian Pac J Cancer Prev, 12, 81-5.
  68. Zhang XZ, Huang XE, Xu YL, et al (2012). Phase II study on voriconazole for treatment of Chinese patients with malignant hematological disorders and invasive aspergillosis. Asian Pac J Cancer Prev, 13, 2415-8. https://doi.org/10.7314/APJCP.2012.13.5.2415
  69. Zhou G, Niu L, Chiu D, et al (2012). Changes in the expression of serum markers CA242, CA199, CA125, CEA, TNF-_ and TSGF after cryosurgery in pancreatic cancer patients. Biotechnol Lett, 34, 1235-41. https://doi.org/10.1007/s10529-012-0908-5
  70. Zhou JN, Huang XE, Ye Z, et al (2009). Weekly paclitaxel/ Docetaxel combined with a paltinum in the treatment of advanced non-samll cell lung cancer: a study on efficacy, safety and pre-medication. Asian Pac J Cancer Prev, 10, 1147-50.

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