Outcomes Based on Risk Assessment of Anastomotic Leakage after Rectal Cancer Surgery

Purpose: Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates,and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection forrectal cancer with a double stapling technique. Patients and
Methods: Data for 460 patients who underwentprimary anterior resection with a double stapling technique for rectal carcinoma at a single institution from2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation.Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according toICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logisticregression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysedusing the Cox regression method.
Results: AL was noted in 35 (7.6%) of 460 patients with rectal cancer. Medianage of the patients was 65 (50–74) and 161 (35%) were male. The diagnosis of AL was made between the 6thand 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004),gender (p=0.007), tumor site (p<0.001), preoperative body mass index (BMI) (p<0.001), the reduction of TSGF on5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD(p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survivalof the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level BMI related (p=0.007)and advanced TNM stage related (p<0.001).
Conclusions: AL after anterior resection for rectal carcinoma isrelated to advanced age, low tumor site, male sex, high preoperative BMI, low pH value of pelvic drainage onPOD 3 and a significant reduction of TSGF on POD 5. In addition to their high risk of immediate postoperativemorbidity and mortality, AL, worse physical status, severe obesity and advanced TNM stage have similarlynegative impact on survival.