Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery

Objective: To review and compare clinical manifestations of and risk factors for anastomotic leakage (AL) after low anterior resection for rectal cancer between minimally invasive surgery (MIS) and open surgery (OS). Background: MIS for rectal cancer has become popular, and its clinical course is different from OS. Many studies have reported on the risk factors and oncologic influence of AL. However, few have directly compared clinical manifestations and risk factors for AL between MIS and OS. Methods: From January 2004 to December 2012, a total of 1704 consecutive patients who underwent elective low anterior resection with colorectal anastomosis for rectal cancer were eligible. The variables associated with short-term outcomes and risk factors were analyzed. Results: The overall AL incidence was 6.4%. In the MIS-AL group, the time to diagnosis of AL and the time to second operation were shorter. A majority of the patients (77.8%) in the MIS-AL group underwent second MIS operation, whereas none in the OS-AL group. The hospital stays after second MIS were shorter than those after second open operation. Multivariate analyses revealed that male sex, smoking and alcohol intake history, previous abdominal surgery, longer operation times, low-lying tumor, and using 2 or more staplers for distal rectal resection were independent risk factors in the MIS-AL group, whereas smoking and alcohol intake history, operation times, and blood loss were significant in the OS-AL group. Conclusions: The clinical manifestations of and risk factors for AL were different between MIS and OS. AL after MIS may be more influenced by factors related to technical difficulties. Close attention should be given to patients undergoing surgery with risk factors for AL.