Risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer: a Meta analysis

Objective To investigate the risk factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer.Methods Literatures on the risk factors of laparoscopic anterior resection of rectal cancer were retrieved from August 2003 to August 2013,and then a Meta analysis was carried out based on the data.Data were expressed by odds ratio (OR) and 95％ confidence interval (95％ CI).The heterogeneity of the data was analyzed using the chi-square test or I2 test.Data were pooled using the fixed or random model.Results Eight literatures including 3 289 patients with rectal cancer were retrieved.The incidence of anastomotic leakage was 6.050％ (199/3 289).The incidence of anastomotic leakage after laparoscopic anterior resection of rectal cancer in males was significantly higher than females (OR =2.17,95％ CI:1.54-3.06,P ＜0.05).Neo-adjuvant chemotherapy might increase the risk of postoperative anastomotic leakage (OR =1.53,95％ CI:1.00-2.32,P ＜ 0.05).Interoperative blood transfusion might increase the risk of postoperative anastomotic leakage (OR =4.80,95％CI:2.98-7.73,P ＜0.05).Patients with low rectal cancer had greater risk of anastomotic leakage than those with high rectal cancer (OR =1.60,95％ CI:1.14-2.23,P ＜ 0.05).Number of linear stapler firings greater than 3 increased the risk of postoperative anastomotic leakage (OR =0.46,95％ CI:0.27-0.78,P ＜ 0.05).The ASA classification of anethesia risk,depth of tumor infiltration,lymph node metastasis,preventive colostomy were not correlated with the incidence of postoperative anastomotic leakage (OR =0.66,0.91,1.25,0.78,95％CI:0.36-1.20,0.55-1.51,0.75-2.09,0.50-1.23,P＞0.05).Conclusion Male,neo-adjuvant chemotherapy,interoperative blood transfusion,low rectal cancer,number of linear stapler firings greater than 3 are the main risk factors for anastomotic leakage after laparoscopic anterior resection of rectal cancer. Key words: Rectal neoplasms ;  Laparoscopy ;  Anastomotic leakage ;  Risk factors ;  Meta analysis