Risk factors for anastomotic leakage and long-term outcomes after laparoscopic right colectomy: a multicenter study in a Japanese rural area.

PURPOSE

This study used a Japanese multicenter database to identify risk factors for anastomotic leakage (AL) and evaluate the long-term outcomes of patients who underwent laparoscopic right colectomy.

METHODS

The subjects of this retrospective review were 729 patients who underwent laparoscopic right colectomy. Clinical features were compared between patients who suffered AL (n = 33) and those who did not (n = 696).

RESULTS

Multivariate analysis identified pulmonary disease (odds ratio [OR] 6.681, 95% confidence interval [CI] 1.495-19.864; p = 0.012), steroid use (OR 10.930, 95%CI 6.131-14.783; p < 0.001), open conversion (OR 12.648, 95%CI 5.479-15.438; p < 0.001), and blood loss ≥ 25 ml (OR 3.260, 95%CI 1.407-7.553; p = 0.005) as independent prognostic factors for AL. The five-year recurrence-free survival (RFS) rates were 43.6% in the AL group and 80.3% in the non-AL group (p = 0.016), while the 5-year overall survival (OS) rates were 71.3% in the AL group and 85.8% in the non-AL group (p = 0.027). Multivariate analysis identified AL (HR 1.519, 95%CI 1.646-3.591; p = 0.037) as the only independent predictor of OS.

CONCLUSIONS

Pulmonary disease, steroid use, and open conversion were identified as risk factors for AL in patients who underwent laparoscopic right colectomy. AL was associated with poor prognosis. Achievement of good short- and long-term results will require careful perioperative management of patients with these risk factors.