Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Purpose: To investigate the risk factors for anastomotic leakage (AL) after anterior resection for rectalcancer with a double stapling technique. Patients and
Methods: Between January 2004 and December 2011,753 consecutive patients in Jiangsu Cancer Hospital and Research Institute diagnosed with rectal cancer andundergoing anterior resection with a double stapling technique were recruited. All patients experienced atotal mesorectal excision (TME) operation. Additionally, decrease of postoperative tumor supplied group offactors (TSGF), which have not been reported before, was proposed as a new indicator for AL. Univariate andmultivariate analysis were performed to determine risk factors for AL.
Results: AL was detected in 57 (7.6%) of753 patients with rectal cancer. The diagnosis of anastomotic leakage was confirmed between the 6th and 12thpostoperative day (POD; mean 8th POD). After univariate analysis and multivariate analysis, age (p<0.001),gender (p=0.002), level of anastomosis (p < 0.001), preoperative body mass index (BMI) (p = 0.001) and reductionof TSGF in 5th POD was less than 10 m/ml (p < 0.001) were selected as 5 independent risk factors for AL. It wasalso indicated that a temporary defunctioning transverse ileostomy (p = 0.04) would decrease the occurrence ofAL.
Conclusion: AL after anterior resection for rectal carcinoma is related to elderly status, low level site of thetumor (below the peritoneal reflection), being male, preoperative BMI and the decrease of TSGF in 5th POD isless than 10 m/ml. Preventive ileostomy is advisable after TME for low rectal tumors to prevent AL.