Abstract: Objective:To investigate the risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer.
Methods:Literatures on the risk factors of laparoscopic anterior resection of rectal cancer were retrieved from August 2003 to August 2013, and then a Meta analysis was carried out based on the data. Data were expressed by odds ratio (OR) and 95% confidence interval (95%CI). The heterogeneity of the data was analyzed using the chisquare test or I2 test. Data were pooled using the fixed or random model.
ResultsEight literatures including 3 289 patients with rectal cancer were retrieved. The incidence of anastomotic leakage was 6.050%(199/3 289). The incidence of anastomotic leakage after laparoscopic anterior resection of rectal cancer in males was significantly higher than females (OR=2.17, 95%CI: 1.54-3.06, P<0.05). Neoadjuvant chemotherapy might increase the risk of postoperative anastomotic leakage (OR=1.53, 95% CI: 1.00-2.32, P<0.05). Interoperative blood transfusion might increase the risk of postoperative anastomotic leakage (OR=4.80, 95%CI: 2.98-7.73, P<0.05). Patients with low rectal cancer had greater risk of anastomotic leakage than those with high rectal cancer (OR=1.60, 95%CI: 1.14-2.23, P<0.05). Number of linear stapler firings greater than 3 increased the risk of postoperative anastomotic leakage (OR=0.46, 95%CI: 0.27-0.78, P<0.05). The ASA classification of anethesia risk, depth of tumor infiltration, lymph node metastasis, preventive colostomy were not correlated with the incidence of postoperative anastomotic leakage (OR=0.66, 0.91, 1.25, 0.78, 95%CI: 0.36-1.20, 0.55-1.51, 0.75-2.09, 0.50-1.23, P>0.05).
Conclusion:Male, neoadjuvant chemotherapy, interoperative blood transfusion, low rectal cancer, number of linear stapler firings greater than 3 are the main risk factors for anastomotic leakage after laparoscopic anterior resection of rectal cancer.