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Meta-analysis of the risk factors for anastomotic leakage after laparoscopic resection of rectal cancer
Ma Jing, Chen Zhenyong, Xiao Weimin, Jiang Chunfang
Journal of Abdominal Surgery ›› 2019, Vol. 32 ›› Issue (5) : 370-375.
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Meta-analysis of the risk factors for anastomotic leakage after laparoscopic resection of rectal cancer
Objective To investigate the risk factors of anastomotic leakage after laparoscopic resection for rectal cancer. Methods PubMed, Wanfang and CNKI were searched for published literature on risk factors of anastomotic leakage after laparoscopic rectal cancer surgery in the past 10 years (2009-2018) Data were extracted and Meta-analysis was performed using R software. Results A total of 25 literatures were included, including 8 papaers of foreign language and 17 papers of Chinese language. A total of 10 545 subjects were included in the study. 559 patients developed postoperative anastomotic fistula, with an incidence rate of 5.30%. Enumeration data were estimated as odds ratios (OR) with 95% confidence intervals (95% CI). Male patients with rectal cancer had a higher incidence of postoperative anastomotic leakage than female patients, with combined OR of 2.22[95%CI:(1.82, 2.72), P < 0.000 1]. Patients aged > 60 years had a higher incidence of postoperative anastomotic leakage than patients aged < 60 years, with combined OR of 1.97[95%CI:(1.46, 2.67), P < 0.000 1]. patients with preoperative serum albumin (ALB) < 35 g/L had a higher incidence of postoperative anastomotic leakage than patients with ALB > 35 g/L, with combined OR of 2.56[95%CI:(1.70, 3.84), P < 0.000 1]. Patients with body mass index (BMI) > 25 kg/m2 had a higher incidence of postoperative anastomotic leakage than patients with BMI < 25 kg/m2. The combined OR was 1.88[95%CI:(1.21, 2.91), P=0.004 9]. The incidence rate was higher in patients who had chemoradiotherapy before resection than those who didn't. The combined OR was 1.86[95%CI:(1.37, 2.52), P < 0.000 1]. the probability of postoperative anastomotic fistula in patients with the distance from the lower edge of tumor to the anal verge < 7 cm was higher than that in patients with the distance > 7 cm, and the combined OR was 2.45 [95%CI:(1.22, 4.93), P=0.011 9]. the risk of postoperative anastomotic fistula in patients with preoperative hemoglobin (Hb) < 110 g/L was higher than that in patients with Hb > 110 g/L, and the combined OR was 1.83 [95%CI: (1.14, 2.95), P=0.012 8]. However, sensitivity analysis suggested that the results were unstable. The risk of postoperative anastomotic fistula in rectal cancer patients with preoperative diabetes was higher than that in patients without diabetes. The combined OR was 1.82[95%CI:(1.31, 2.53), P=0.000 4]. The incidence rate in patients with T3 and T4 was higher than those with T1 and T2 [OR=1.32, 95%CI:(1.07, 1.63), P=0.009 6]. Conclusion In addition to Hb, the above 8 items are all high risk factors of postoperative anastomotic leakage in patients with rectal cancer under laparoscopy. The effect of preoperative Hb level on anastomotic leakage needs further study.
Laparoscopic / Rectal cancer / Anastomotic leakage / Risk factors / Meta-analysis {{custom_keyword}} /
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