Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2020; 12(10): 425-434
Published online Oct 27, 2020. doi: 10.4240/wjgs.v12.i10.425
Narrow pelvic inlet plane area and obesity as risk factors for anastomotic leakage after intersphincteric resection
Akira Toyoshima, Toshihiro Nishizawa, Eiji Sunami, Ryuji Akai, Takahiro Amano, Akiyoshi Yamashita, Shin Sasaki, Takeshi Endo, Yoshihiro Moriya, Osamu Toyoshima
Akira Toyoshima, Ryuji Akai, Takahiro Amano, Shin Sasaki, Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
Toshihiro Nishizawa, Department of Gastroenterology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
Toshihiro Nishizawa, Osamu Toyoshima, Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
Eiji Sunami, Department of Surgery, The University of Kyorin, Tokyo 113-8655, Japan
Akiyoshi Yamashita, Department of Radiology, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
Takeshi Endo, Tokyo Midtown Clinic, Tokyo 107-6206, Japan
Yoshihiro Moriya, Miki Hospital, Iwate 029-4201, Japan
Author contributions: Toyoshima A is the lead investigator, performed operations, collected and analyzed the data, and wrote the manuscript; Nishizawa T performed the literature search and statistical analysis and wrote the manuscript; Sunami E performed the operations; Akai R and Amano T assisted the operations; Yamashita A drafted the conception; Sasaki S supervised the study and approved the final manuscript; Toyoshima O contributed to data management, interpretation, and revision.
Institutional review board statement: This retrospective study was approved by the ethics review board of the Japanese Red Cross Medical Center on July 31, 2019.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The manuscript was revised according to the STROBE Statement.
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:
Corresponding author: Akira Toyoshima, MD, Doctor, Department of Colorectal Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan.
Received: June 19, 2020
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
Research background

Intersphincteric resection (ISR) has been increasingly used as the ultimate sphincter-preserving procedure in extremely low rectal cancer.

Research motivation

Anastomotic leakage is the most critical complication that can cause reduced function or narrowing of the anal sphincter, possibly warranting a permanent colostomy.

Research objectives

This study investigated risk factors for anastomotic leakage after ISR based on clinicopathological variables and pelvimetry.

Research methods

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.

Research results

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%.

Research conclusions

Narrow pelvic inlet and obesity were independent risk factors for anastomotic leakage after ISR.

Research perspectives

A follow-up study should be performed to confirm and clarify the characteristics of anastomotic leakage after ISR including laparoscopic surgery.