Risk factors for anastomotic leakage in rectal cancer surgery. A retrospective cohort study.

Abstract

PURPOSE Anastomotic leakage after restorative surgery for rectal cancer is associated with significant morbidity and mortality. Several factors have been identified as risk factors for anastomotic leakage. In this retrospective cohort study, we examined cases of anastomotic leakage in rectal surgery and tried to ascertain the risk factors. METHODS A review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated to identify risk factors for anastomotic leakage. RESULTS The overall incidence of anastomotic leakage was 10.4%, with a mean time interval of 6.2 +/-2.1 days. Overall mortality was 0.8%. Mortality was higher in patients with anastomotic leakage (4.9%) than in patients without leak (0.4%, P =0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index <40 points, tumour diameter and intraoperative blood loss were identified as risk factors for anastomotic leakage. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to anastomotic leakage in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube significantly did. CONCLUSION Clinical, surgical and pathological factors are associated with an increased risk of anastomotic leakage. It adversely affects the morbidity and mortality of rectal cancer patients.