Year 2018 Vol. 26 No 6




Kazan State Medical University 1,
Tatarstan Regional Clinical Cancer Center2, Kazan
I. N. Ulianov Chuvash State University3, Cheboksary,
The Russian Federation

Objective. To work out a multifactorial prognostic model for the development of inconsistency of colorectal anastomosis sutures after sphincter-saving operations on the rectum for cancer.
Methods. The work is based on the study of 145 patients who were subject to low and ultra-low intra-abdominal resections of the rectum for cancer; there were 65 males, 80 females. The average age of patients was 66.110.81 years, there were 95 patients (76.6%) over the age of 60 and 54 (37.3%) over 70. The following parameters were analyzed: gender, age, body mass index, anesthesia assessment according to ASA, concomitant diseases, tumor stage, tumor level from the anus, volume of operation, anastomosis level from the anus, postoperative complications. The multifactorial prognostic model of the development of the anastomosis sutures failure is based on the binary logistic regression method.
Results. The colorectal anastomoses sutures failure has developed in 23 patients (15.9%). No patient was reoperated because of the formation of an intestinal stoma. The following statistically significant factors of the inconsistency of the colorectal anastomosis sutures were obtained: the anastomosis level from the anus, the level of the tumor to the anus, the body mass index, the presence of coronary heart disease, the status of anesthesia in ASA (p <0.001, p=0.002, p=0.035, p<0.001, p=0.037, respectively). Based on the information about the influence of various factors on the incidence of the sutures failure of colorectal cancer, a prognostic model was designed that was transformed into a computer program to simplify the use in the practice of a doctor.
Conclusions. The developed multifactorial prognostic model and its implementation in the form of a simple computer program enables physicians to assess the risk of development of the colorectal sutures failure on the basis of several statistically significant factors and apply appropriate measures to prevent postoperative complications after low and ultra-low rectal resections for cancer.

Keywords: colorectal cancer, colorectal anastomosis, anastomosis leakage, prognosis, software
p. 707-714 of the original issue
  1. Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, Jemal A. Colorectal cancer statistics, 2017. CA Cancer J Clin. 2017 May 6;67(3):177-93. doi: 10.3322/caac.21395
  2. Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016 Jul;66(4):271-89. doi: 10.3322/caac.21349
  3. Stevenson ARL. The future for laparoscopic rectal cancer surgery. Br J Surg. 2017;104(6):643-45. doi: 10.1002/bjs.10503
  4. Kang CY, Halabi WJ, Chaudhry OO, Nguyen V, Pigazzi A, Carmichael JC, Mills S, Stamos MJ. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2013 Jan;148(1):65-71. doi: 10.1001/2013.jamasurg.2
  5. Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg. 1999 Dec;189(6):554-59. doi: 10.1016/S1072-7515(99)00207-0
  6. Fouda E, El Nakeeb A, Magdy A, Hammad EA, Othman G, Farid M. Early detection of anastomotic leakage after elective low anterior resection. J Gastrointest Surg. 2011 Jan;15(1):137-44. doi: 10.1007/s11605-010-1364-y
  7. Caulfield H, Hyman NH. Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg. 2013 Feb;148(2):177-82. doi: 10.1001/jamasurgery.2013.413
  8. Wu Z, van de Haar RC, Sparreboom CL, Boersema GS, Li Z, Ji J, Jeekel J, Lange JF. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis. 2016 Aug;31(8):1409-17. doi: 10.1007/s00384-016-2616-4
  9. Cauchy F, Abdalla S, Penna C, Angliviel B, Lambert B, Costaglioli B, Brouquet A, Benoist S. The small height of an anastomotic colonic doughnut is an independent risk factor of anastomotic leakage following colorectal resection: results of a prospective study on 154 consecutive cases. Int J Colorectal Dis. 2017 May;32(5):699-707. doi: 10.1007/s00384-017-2769-9
  10. Jatal S, Pai VD, Demenezes J, Desouza A, Saklani AP. Analysis of risk factors and management of anastomotic leakage after rectal cancer surgery: an Indian Series. Indian J Surg Oncol. 2016 Mar;7(1):37-43. doi: 10.1007/s13193-015-0457-1
  11. Parthasarathy M, Greensmith M, Bowers D, Groot-Wassink T. Risk factors for anastomotic leakage after colorectal resection: a retrospective analysis of 17 518 patients. Colorectal Dis. 2017 Mar;19(3):288-98. doi: 10.1111/codi.13476
  12. Akhmetzyanov FSh, Shaykhutdinov NT, Valiev NA, Shemeunova ZN, Egorov VI. Aspiration drainage in the prevention of postoperative septic complications in rectum sphincter-sparing abdominoperitoneal resection. Kazan Med Zhurn. 2015;96(6):935-39. doi: 10.17750/KMJ2015-935 (in Russ.)
  13. Hong J, Han YD, Zhu XC, Li XN, Li C, Yang J, Shi LS. Indications of preventive ileostomy in sphincter-preserving surgery for patients with rectal cancer. Int J Clin Exp Med. 2016;9(5):8506-13.
  14. Man VC, Choi HK, Law WL, Foo DC. Morbidities after closure of ileostomy: analysis of risk factors. Int J Colorectal Dis. 2016 Jan;31(1):51-57. doi: 10.1007/s00384-015-2327-2
  15. Kornmann VN, Walma MS, de Roos MA, Boerma D, van Westreenen HL. Quality of life after a low anterior resection for rectal cancer in elderly patients. Ann Coloproctol. 2016 Feb;32(1):27-32. doi: 10.3393/ac.2016.32.1.27
Address for correspondence:
420012, The Russian Federation,
Kazan, Baturin Str., 49,
Kazan State Medical University,
Department of Oncology,
X-ray Diagnostics and Radiotherapy,
Tel. office: +7 927 429 96 71,
Vasiliy I. Egorov
Information about the authors:
Akhmetzyanov Foat Sh., MD, Professor, Head of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Head of the Tatarstan Regional Clinical Cancer Center, Kazan, Russian Federation.
Egorov Vasiliy I., PhD, Assistant of the Department of Oncology, X-ray Diagnostics and Radiotherapy, Kazan State Medical University, Oncologist of the General Oncology Unit of Tatarstan Regional Clinical Cancer Center, Kazan, Russian Federation.
Fomin Aleksey I., Applicant for Masters Degree of the Faculty of Informatics and Computer Science, I. N. Ulianov Chuvash State University, Cheboksary, Russian Federation.
Kokshin Alexander V., Post-Graduate Student of the Department of Neurosurgery, Kazan State Medical University, Kazan, Russian Federation.
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