Risk Factors for Anastomotic Leakage after a Low Anterior Resection for Rectal Cancer

Yoon, Seok jun; Kim, Jin soo; Min, Byung so; Kim, Nam Kyu; Baik, Seung Hyuk; Lee, Kang Young; Sohn, Seung Kook; Cho, Jang Hwan

Abstract

PURPOSE: Clinical anastomotic leakage remains a major problem after a low anterior resection for rectal cancer, so indentifing risk factors influencing anastomotic leakage is important. The aim of this study was to assess the association between risk factors and anastomotic leakage.
RESULTS
One thousand two hundred eight patients underwent a primary resection for rectal cancer from June 1993 to March 2007. We used hospital records and the colorectal cancer registry to analyze retrospectively the case histories of those patients. The operations were performed using a low anterior resection with the double stapling method. All patients underwent a tumor-specific mesorectal excision. Of the total, thirty-eight patients showed anastomotic leakage. Univariate and multivariate analyses were performed to assess the risk factors affecting to the anastomotic leakage.
RESULTS
The rate of anastomotic leakage was 3.2% (38 of 1,208 patients) with a mortality rate of 7.9% (3 of 38 patients). The overall mortality rate was 0.3% (3 of 1,208 patients). Males accounted for 28 of the 38 patients with leakage, and female accounted for the the account for the remnant 10. The mean age was 53.7 years (33~74 years). The mean leakage day was 11.8th day (3~37th day) after the operation, and the mean hospital day was 39.2 days (7~131 days). The mean body mass index (BMI) was 22.7 kg/m2 (15.7~30.8 kg/m2). The mean operation time was 230.5 minutes (90~425 minutes), and the mean bleeding loss was 519.5 cc (0~3,500 cc).
CONCLUSIONS
Significant risk factors for anastomotic leakage after primary resection for rectal cancer were the transfusion amount during surgery, a preliminary colostomy, and nodal stage.