Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer
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Anterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory. The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. Material and methods. This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI < 23.8 kg/m2 (lower quartile); group II, BMI between 23.8 and 29.38 kg/m2 (middle quartile); and group III, BMI > 29.38 kg/m2 (upper quartile). Results. Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53). Conclusions. The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer.
1 - 3 - 2015
2 - 3 - 2015
3 - 7 - 2015
- 1. Renehan AG, Tyson M, Egger M et al.: Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371: 569-78.
- 2. Bardou, Marc, Alan N. Barkun et al.: Obesity and colorectal cancer. Gut 2013; 62: 933-47
- 3. Renehan AG, Egger M, Saunders MP et al.: Impact on survival of intensive follow up after curative resection for colorectal cancer: systematic review and meta-analysis of randomised trials. BMJ 2002; 324: 813.
- 4. Jones OM , John SK , Horseman N et al.: Low anastomotic leak rate after colorectal surgery: a single- centre study. Colorectal Dis 2007; 9: 740-44.
- 5. Påhlman L, Bohe M, Cedermark B et al.: The Swedish rectal cancer registry. Br J Surg 2007; 94: 1285-92.
- 6. Law WL , Choi HK , Lee YM et al.: The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol 2007; 14: 2559-66.
- 7. Szczepkowski M, Banasiewicz T, Krokowicz P et al.: Polish Consensus Statement On The Protective Stoma. Pol Przegl Chir 2014; 86: 391-404.
- 8. Rullier E, Laurent C, Garrelon JL et al.: Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998; 85: 355-58.
- 9. Bokey L, Chapuis PH, Dent OF: Impact of Obesity on Complications After Resection for Rectal Cancer. Colorectal Dis 2014; 6: 896-906.
- 10. Campbell PT, Newton CC , Dehal AN et al.: Impact of body mass index on survival after colorectal cancer diagnosis: the Cancer Prevention Study-II Nutrition Cohort. J Clin Oncol 2012; 30: 42-52.
- 11. Didkowska J, Wojciechowska U, Zatoński W: Nowotwory złośliwe w Polsce w 2011 roku. Centrum Onkologii-Instytut, Warszawa 2013.
- 12. How P, Shihab O, Tekkis P et al.: A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011; e149-55.
- 13. Piecuch J, Wiewiora M, Jopek J et al.: Mortality and anastomotic leakage after anterior resection for rectal cancer. Hepatogastroenterology 2012; 59: 721-23.
- 14. Kruschewski M, Rieger H, Pohlen U et al.: Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 2007; 22: 919-27.
- 15. Ziegler MA1, Catto JA, Riggs TW et al.: Risk Factors for Anastomotic Leak and Mortality in Diabetic Patients Undergoing Colectomy. Arch Surg 2012; 147: 600-05.
- 16. Kang CY , Halabi WJ , Chaudhry OO et al.: Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 2013; 148: 65-71.
- 17. Pommergaard HC , Gessler B, Burcharth J et al.: Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 2014; 16: 662-71.
- 18. Matthiessen P, Hallbook O, Andersson M i wsp.: Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004; 6: 462-69.
- 19. Giovannucci E, Ascherio A, Rimm EB et al.: Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 1995; 1225: 327-34.
- 20. Frezza EE , Wachtel MS , Chiriva-Internati M: Influence of obesity on the risk of developing colon cancer. Gut 2006; 55: 285-91.
- 21. Roberts DL , Dive C, Renehan AG: Biological mechanisms linking obesity and cancer risk: new perspectives. Ann Rev Med 2010; 61: 301-16.
- 22. Wolin KY , Carson K, Colditz GA: Obesity and cancer. Oncologist 2010; 15: 556-65.
- 23. Ballian N, Yamane B, Leverson G et al.: Body mass index does not affect postoperative morbidity and oncologic outcomes of total mesorectal excision for rectal adenocarcinoma. Ann Surg Oncol 2010; 17: 1606-13.
- 24. Poulsen M, Ovesen H: Is laparoscopic colorectal cancer surgery in obese patients associated with an increased risk? Short-term results from a single center study of 425 patients. J Gastrointest Surg 2012; 16: 1554-58.
- 25. Konishi T, Watanabe T, Kishimoto J et al.: Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 2006; 202: 439-44.
- 26. O’Connell JB, Maggard MA, Ko CY : Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 2004; 96: 1420-25.
- 27. Walker KG , Bell SW , Rickard MJ et al.: Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 2004; 240: 255.
- 28. Eriksen M, Wibe A, Norstein J et al.: Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005; 7: 51-57.
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