Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2015; 21(19): 5910-5917
Published online May 21, 2015. doi: 10.3748/wjg.v21.i19.5910
Risk factors causing structural sequelae after anastomotic leakage in mid to low rectal cancer
Woong Bae Ji, Jung Myun Kwak, Jin Kim, Jun Won Um, Seon Hahn Kim
Woong Bae Ji, Jung Myun Kwak, Jin Kim, Jun Won Um, Seon Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea
Author contributions: Ji WB performed the research, analyzed the data, and wrote the paper; Kwak JM designed the research and analyzed the data; Kim J, Um JW, and Kim SH contributed analytical tools and reviewed this study.
Ethics approval: The study was reviewed and approved by the Korea University Anam Hospital Institutional Review Board.
Informed consent: All study participants, or their legal guardians, provided informed written consent prior to study enrollment.
Conflict-of-interest: We have no potential or actual personal, political, or financial conflicts of interest to declare.
Data sharing: No additional data are available.
Open-Access: 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/
Correspondence to: Jung Myun Kwak, MD, Department of Surgery, Korea University Anam Hospital, 73, Inchon-ro, Seongbuk-gu, Seoul 136-705, South Korea. jmkwak@korea.ac.kr
Telephone: +82-2-9205323 Fax: +82-2-9281631
Received: October 14, 2014
Peer-review started: October 16, 2014
First decision: December 2, 2014
Revised: December 31, 2014
Accepted: February 5, 2015
Article in press: February 5, 2015
Published online: May 21, 2015
Abstract

AIM: To investigate the risk factors causing structural sequelae after anastomotic leakage in patients with mid to low rectal cancer.

METHODS: Prospectively collected data of consecutive subjects who had anastomotic leakage after surgical resection for rectal cancer from March 2006 to May 2013 at Korea University Anam Hospital were retrospectively analyzed. Two subgroup analyses were performed. The patients were initially divided into the sequelae (stricture, fistula, or sinus) and no sequelae groups and then divided into the permanent stoma (PS) and no PS groups. Univariate and multivariate analyses were performed to identify the risk factors of structural sequelae after anastomotic leakage.

RESULTS: Structural sequelae after anastomotic leakage were identified in 29 patients (39.7%). Multivariate analysis revealed that diversion ileostomy at the first operation increases the risk of structural sequelae [odds ratio (OR) = 6.741; P = 0.017]. Fourteen patients (17.7%) had permanent stoma during the follow-up period (median, 37 mo). Multivariate analysis showed that the tumor level from the dentate line was associated with the risk of permanent stoma (OR = 0.751; P = 0.045).

CONCLUSION: Diversion ileostomy at the first operation increased the risk of structural sequelae of the anastomosis, while lower tumor location was associated with the risk of permanent stoma in the management of anastomotic leakage.

Keywords: Anastomotic leakage, Permanent stoma, Leakage sequelae, rectal cancer, Anastomotic leakage fate

Core tip: This study aimed to find the risk factors causing structural sequelae of anastomotic site after leakage in rectal cancer patients. Anastomotic leakage is one of the most challenging complications. Even after patients recover from the acute complication phase, they can suffer from its structural sequelae including stricture, fistula, sinus, or permanent stoma. No studies have evaluated the risk factors causing structural sequelae of anastomosis after leakage. Here we report our data about the fate of anastomotic leakage and the risk factors that should be considered after anastomotic leakage in patients with rectal cancer.