open access
Vol 64, No 5 (2014)
Review paper
Published online: 2014-11-06
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Prognostic risk factors of anastomotic leakage following anterior resection in patients with rectal cancer: when is a protective stoma needed? Literature review of 15 457 patients
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DOI: 10.5603/NJO.2014.0069
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Nowotwory. Journal of Oncology 2014;64(5):401-414.
open access
Vol 64, No 5 (2014)
Review article
Published online: 2014-11-06
Abstract
Identification of the risk factors of symptomatic anastomotic leakage (AL) after anterior resection in patients withrectal cancer. A review was made of the literature from 1 January 2000 to 31 December 2013. Studies were identified by an electronic search of the PubMed database with the keywords “anterior resection, anastomotic leakage, risk factors”. Only English-language studies were included. These focused on laparoscopic resection, quality of life, protective stoma and surgery technique, ‘non rectal’ cancer, oncological outcomes were excluded. Studies based on small numbers of patients (which we define as fewer than 100) were also excluded from the review, which is based on an analysisof data from 26 publications. The literature review identified 53 preoperative and intraoperative factors which could be potentially associated with the risk of AL. Among them, 22 have been identified as an independent risk factors for leaks in at least one publication and 10 risk factors in more than one study. The most important factors relating to anastomotic leakage were: male gender, age ≥ 60 years, tumor located ≤ 10 cm from the anal verge, preoperative radiotherapy, smoking, diabetes, low level of the anastomosis, blood loss, blood transfusion and intraoperative complications. The identification of risk factors of AL alone does not allow to indicate precisely when the construction of a protective stoma is indeed mandatory. Thus, further prospective studies are recommended.
Abstract
Identification of the risk factors of symptomatic anastomotic leakage (AL) after anterior resection in patients withrectal cancer. A review was made of the literature from 1 January 2000 to 31 December 2013. Studies were identified by an electronic search of the PubMed database with the keywords “anterior resection, anastomotic leakage, risk factors”. Only English-language studies were included. These focused on laparoscopic resection, quality of life, protective stoma and surgery technique, ‘non rectal’ cancer, oncological outcomes were excluded. Studies based on small numbers of patients (which we define as fewer than 100) were also excluded from the review, which is based on an analysisof data from 26 publications. The literature review identified 53 preoperative and intraoperative factors which could be potentially associated with the risk of AL. Among them, 22 have been identified as an independent risk factors for leaks in at least one publication and 10 risk factors in more than one study. The most important factors relating to anastomotic leakage were: male gender, age ≥ 60 years, tumor located ≤ 10 cm from the anal verge, preoperative radiotherapy, smoking, diabetes, low level of the anastomosis, blood loss, blood transfusion and intraoperative complications. The identification of risk factors of AL alone does not allow to indicate precisely when the construction of a protective stoma is indeed mandatory. Thus, further prospective studies are recommended.
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About this articleTitle
Prognostic risk factors of anastomotic leakage following anterior resection in patients with rectal cancer: when is a protective stoma needed? Literature review of 15 457 patients
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Pages
401-414
Published online
2014-11-06
Page views
969
Article views/downloads
7054
DOI
10.5603/NJO.2014.0069
Bibliographic record
Nowotwory. Journal of Oncology 2014;64(5):401-414.
Authors
Andrzej Rutkowski
Tomasz Olesiński
Leszek Zając