Risk factors for anastomotic leakage after resection of rectal cancer

TLDR

Symptomatic anastomotic leakage after rectal resection is the most serious complication, occurring in 6–22 % of cases and carrying a high mortality rate. This retrospective study aimed to identify risk factors for clinical anastomotic leakage following anterior resection for rectal cancer. The authors analyzed 272 consecutive anterior resections (131 low anastomoses) performed between 1980 and 1995, examining 19 patient, tumour, surgical, and treatment variables using univariate and multivariate methods. Multivariate analysis identified male sex and low anastomosis level (<5 cm) as independent predictors of leakage, with low anastomoses carrying a 6.5‑fold higher risk and men a 2.7‑fold higher risk; in low anastomoses, obesity was also associated, and a protective stoma is advised for men and obese patients.

Abstract

The most important surgical complication following rectal resection with anastomosis is symptomatic anastomotic leakage, which is associated with a 6-22 per cent mortality rate. The aim of this retrospective study was to evaluate the risk factors for clinical anastomotic leakage after anterior resection for cancer of the rectum.From 1980 to 1995, 272 consecutive anterior resections for rectal cancer were performed by the same surgical team; 131 anastomoses were situated 5 cm or less from the anal verge. The associations between clinical anastomotic leakage and 19 patient-, tumour-, surgical-, and treatment-related variables were studied by univariate and multivariate analysis.The rate of clinical anastomotic leakage was 12 per cent (32 of 272). Multivariate analysis of the overall population showed that only male sex and level of anastomosis were independent factors for development of anastomotic leakage. The risk of leakage was 6.5 times higher for anastomoses situated less than 5 cm from the anal verge than for those situated above 5 cm; it was 2.7 times higher for men than for women. In a second analysis of low anastomoses (5 cm or less from the anal verge; n = 131), obesity was statistically associated with leakage.A protective stoma is suitable after sphincter-saving resection for rectal cancer for anastomoses situated at or less than 5 cm from the anal verge, particularly for men and obese patients.