Risk factors for anastomotic leakage after laparoscopic intersphincteric resection for low-lying rectal cancer

Objective To investigate the risk factors for anastomotic leakage (AL) after laparoscopic intersphincteric resection (Lap-ISR) for patients with low-lying rectal cancer. Methods This retrospective study was conducted in the Characteristic Medical Center of PLA Rocket Force from Jun 2011 to Nov 2018. 151 patients undergoing Lap-ISR were enrolled for this study. Results All patients in this series had a defunctioning ileostomy. The overall leakage rate was 17.2% (26/151), including peri-operative AL (n=20) and delayed AL (n=6). In accordance with the grading system of the International Study Group of Rectal Cancer, there were 24 patients (15.9%) with AL Grade B (requiring active therapeutic intervention) and two patients (1.3%) with AL Grade C (requiring re-laparotomy). Univariate analysis showed that BMI (≥ 25 kg/m2), tumor annularity (≥ 3/4) and operation time (≥ 240 min) were associated with AL (P<0.05). Multivariate analysis showed that operation time (≥ 240 min, OR=7.390, 95% CI: 2.483-21.988, P=0.000), tumor annularity (≥ 3/4, OR=6.233, 95% CI: 1.932-20.107, P=0.002) and higher BMI (≥ 25 kg/m2,OR=3.523, 95% CI: 1.275-9.738, P=0.015) were independently predictive of AL. Conclusion Tumor annularity, operation time and higher BMI are independently associated with symptomatic AL after Lap-ISR. Key words: Rectal neoplasms; Anastomotic leakage; Risk factors; Laparoscopy