Determining the protective characteristics and risk factors for the development of anastomotic leakage after low anterior resection for rectal cancer

Surg Today. 2021 May;51(5):713-720. doi: 10.1007/s00595-020-02133-0. Epub 2020 Oct 2.

Abstract

Purpose: Anastomotic leakage is one of the most serious postoperative complications associated with surgery for rectal cancer. The present study aimed to identify the protective characteristics and risk factors associated with anastomotic leakage after low anterior resection for rectal cancer.

Methods: This was a retrospective, single-center study conducted between January 2009 and December 2017 at our institution. In total, 136 rectal cancer patients who underwent low anterior resection were included in the study. We analyzed preoperative and intraoperative factors. In addition, the pelvic dimensions were measured using computed tomography in all cases.

Results: Among the 136 patients, anastomotic leakage occurred in 21 (15.4%), including 18 males and 3 females. The median body mass index was 21.1 kg/m2. The construction of a covering stoma was found to be a protective factor. In addition, the operation time (≥ 373 min), intraoperative blood loss (≥ 105 ml), and size of the pelvic inlet (≥ 113 mm) were identified as risk factors for anastomotic leakage.

Conclusion: The construction of a covering stoma was a possible protective factor. However, a longer operation time, higher intraoperative blood loss, and larger pelvic inlet dimensions were possible risk factors for developing anastomotic leakage after low anterior resection in patients with rectal cancer.

Keywords: Anastomotic leak; Colorectal surgery; Pelvic index; Rectal cancer; Risk factor.

MeSH terms

  • Aged
  • Anastomosis, Surgical / adverse effects*
  • Anastomosis, Surgical / methods*
  • Anastomotic Leak / etiology*
  • Anastomotic Leak / prevention & control*
  • Blood Loss, Surgical / statistics & numerical data
  • Digestive System Surgical Procedures / adverse effects*
  • Digestive System Surgical Procedures / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Operative Time
  • Pelvis / anatomy & histology
  • Postoperative Complications / etiology*
  • Postoperative Complications / prevention & control*
  • Protective Factors
  • Rectal Neoplasms / surgery*
  • Retrospective Studies
  • Risk Factors
  • Surgical Stomas