A scoring system to predict the risk of anastomotic leakage after anterior resection for rectal cancer

Abstract

BACKGROUND: Various risk factors for anastomotic leakage after anterior resection for rectal cancer have been documented in previous studies. However, there have been no quantized studies to more accurately predict the risk of anastomotic leakage. METHODS: A total of 1,060 patients with rectal cancer who underwent anterior resection were included in the study. Potential risk factors for leakage including gender, age, body mass index (BMI), diabetes, preoperative radiotherapy, tumor size, level of anastomosis, intraoperative blood loss, concomitant resection of other organs and TNM stage were subjected to univariate analysis. Multivariate logistic regression analysis was used to identify the independent risk factors for anastomotic leakage. The scoring system was developed based on regression coefficient for each significant risk factor. RESULTS: Independent risk factors included male gender, low level of anastomosis from anal verge and high-volume intraoperative blood loss. These patients were separated into high risk, intermediate risk and low risk groups based on scores of 4-5, 2-3, and 0-1. The leakage rates of the three groups were 16.1%, 8.0%, and 1.9%, respectively (P < 0.001). CONCLUSIONS: The scoring system is effective and accurate for identifying a subgroup of patients at high risk for leakage.