Retrospective Study
Copyright ©The Author(s) 2022.
World J Gastrointest Surg. Aug 27, 2022; 14(8): 821-832
Published online Aug 27, 2022. doi: 10.4240/wjgs.v14.i8.821
Table 1 Baseline characteristics of patients (n = 319)
VariablesReinforcing sutures
P value
Yes, n = 168
No, n = 151
Age (yr)61.8 ± 8.763.0 ± 9.70.229
Men/Women80/8873/780.897
BMI (kg/m2)23.2 ± 3.622.8 ± 3.80.378
ASA score, n (%)0.948
160 (35.7)54 (35.8)
267 (39.9)61 (40.4)
341 (24.4)36 (23.8)
Tumor diameter (cm)4.4 ± 1.74.1 ± 1.80.178
Tumor site (from anal verge, cm), n (%)0.641
≥ 5123 (73.2)114(75.5)
< 545 (26.8)37(24.5)
Depth of tumor invasion, n (%)0.295
T1-T233 (19.6)37 (24.5)
T3-T4135 (80.4)114 (75.5)
Lymph node metastases, n (%)0.493
Yes77 (45.8)75 (49.7)
No91 (54.2)76 (50.3)
Diabetes mellitus, n (%)31 (18.5)22 (14.6)0.352
Hypertension, n (%)37 (22.0)25 (16.6)0.218
Heart disease, n (%)18 (10.7)11 (7.3)0.287
COPD, n (%)9 (5.4)7 (4.6)0.768
Previous abdominal surgery, n (%)17 (10.1)14 (9.3)0.799
Preoperative CEA (ng/mL), n (%)0.430
≥ 557 (33.9)45 (29.8)
< 5111 (66.1)106 (70.2)
Preoperative hemoglobin levels (g/L), n (%)0.239
≥ 90138 (82.1)116 (76.8)
< 9030 (17.9)35 (23.2)
Preoperative serum albumin level (g/L), n (%)0.301
≥ 35139 (82.7)118 (78.1)
< 3529 (17.3)33 (21.9)
Preoperative serum CRP level (mg/L), n (%)0.375
≥ 1028 (16.7)28 (20.5)
< 10140 (83.3)123 (79.5)
Table 2 Surgical outcomes and postoperative complications
VariablesReinforcing sutures
P value
Yes, n = 168
No, n = 151
Left colic artery ligation, n (%)0.637
Yes79 (47.0)75 (49.7)
No89 (53.0)76 (50.3)
Number of staple firings, n (%)0.902
≥ 316 (9.5)15 (9.9)
< 3152 (90.5)136 (90.1)
Operation time (min)150.4 ± 25.1146.6 ± 20.20.135
Intraoperative transfusion, n (%)20 (11.9)15 (9.9)0.574
Intraoperative blood loss (mL)60.5 ± 43.958.2 ± 46.30.652
Complications, n (%)
Anastomotic leakage8 (4.8)17 (11.3)0.031
Postoperative intestinal obstruction25 (14.9)17 (11.3)0.339
Anastomosis stricture12 (7.1)17 (13.1)0.202
Postoperative defecation dysfunction, 3 mo31 (18.5)25 (16.6)0.657
Postoperative defecation dysfunction, 6 mo23 (13.7)21 (13.9)0.955
Postoperative defecation dysfunction, 12 mo12 (7.1)9 (6.0)0.671
Table 3 Anastomotic leakage related indices (n = 25)
Reinforcing sutures
P value
Yes, n = 8
No, n = 17
AL classification0.020
Grade A32
Grade B32
Grade C213
AL time (d)5 (2–7)4 (1–7)0.715
Treatment
Trans-anal lavage and drainage210.231
Peritoneal lavage and drainage111.000
Reoperation2130.028
Table 4 Univariate and multivariate regression on anastomotic leakage-related factors (n = 319)
VariablesUnivariate regression
Multivariate regression
OR
95%CI
P value
OR
95%CI
P value
Male gender1.1890.523–2.7050.680
Age ≥ 60 (yr)2.1230.824–5.4730.119
BMI ≥ 25 (kg/m2)1.1150.448–2.7750.814
Diabetic mellitus2.6041.060–6.3940.0371.6620.588–4.6690.338
Hypertension1.0390.374–2.8880.941
Heart disease2.0500.652–6.4410.219
COPD1.7390.372–8.1240.482
Low tumor location < 5 (cm)2.9541.289–6.7690.0102.8561.133–7.1980.026
Tumor diameter ≥ 4 (cm)3.0101.313–6.9010.0092.9941.185–7.5630.020
T3-T41.1350.410–3.1420.807
Lymph node metastases1.7190.748–3.9510.202
Previous laparotomy1.8840.602–5.8900.276
Preoperative CEA ≥ 5 (ng/mL)1.2160.518-2.8520.653
Preoperative serum albumin level < 35 (g/L)1.6900.673–4.2440.264
Preoperative hemoglobin levels < 90 (g/L)1.5820.631–3.9670.328
Preoperative serum CRP level, ≥ 10 (mg/L)2.2420.918–5.4760.076
ASA score ≥ 31.2440.499–3.1020.639
Ligation of left colic artery2.4351.019–5.8190.0452.1950.869–5.5460.096
Operation time ≥ 150 (min)2.4371.059–5.6130.0361.8370.750–4.4950.183
Number of staple firings ≥ 32.5770.893–7.4340.080
Intraoperative transfusion1.1160.316–3.9390.864
Intraoperative blood loss ≥ 60 (mL)1.2230.537–2.7870.632
Reinforcing sutures0.3940.165–0.9420.0360.2930.114–0.7500.010
Postoperative intestinal obstruction2.2630.848–6.0410.103
Table 5 Subgroup analysis of the effectiveness of reinforcing sutures
Reinforcing suturesAnastomotic leakage
P value
Yes
No
Low-risk group0.368
Yes187
No485
High-risk group0.038
Yes773
No1349