Published online Oct 27, 2020. doi: 10.4240/wjgs.v12.i10.425
Peer-review started: June 19, 2020
First decision: July 30, 2020
Revised: August 12, 2020
Accepted: September 14, 2020
Article in press: September 14, 2020
Published online: October 27, 2020
Intersphincteric resection (ISR) has been increasingly used as the ultimate sphincter-preserving procedure in extremely low rectal cancer.
Anastomotic leakage is the most critical complication that can cause reduced function or narrowing of the anal sphincter, possibly warranting a permanent colostomy.
This study investigated risk factors for anastomotic leakage after ISR based on clinicopathological variables and pelvimetry.
We enrolled 117 patients with extremely low rectal cancer who underwent laparotomic and laparoscopic ISRs. Risk factors for anastomotic leakage after ISR that were analyzed using a multivariate analysis. Pelvic dimensions were measured using three-dimensional reconstruction of computed tomography images. The optimal cutoff value of the pelvic inlet plane area that predicts anastomotic leakage was determined using a receiver operating characteristic curve.
Higher body mass index and small pelvic inlet plane area were independently associated with anastomotic leakage after ISR. According to the receiver operating characteristic curves, the optimal cutoff value of the pelvic inlet plane area was 10074 mm2. Narrow pelvic inlet plane area (≤ 10074 mm2) predicted anastomotic leakage with a sensitivity of 90%, a specificity of 85.9%, and an accuracy of 86.3%.
Narrow pelvic inlet and obesity were independent risk factors for anastomotic leakage after ISR.
A follow-up study should be performed to confirm and clarify the characteristics of anastomotic leakage after ISR including laparoscopic surgery.