Risk factors for anastomotic leakage after resection for rectal cancer

Background/Aims: The aim of this study was to identify risk factors for anastomotic leakage in patients that have received a resection for rectal cancer. Methodology: Between January 1996 and December 2002, 499 patients underwent rectal resection for rectal cancer performed by the same surgeon, and of these 25 patients developed anastomotic leakage. For this case-control study, we selected two age- (not more than 5 years), sex-, and date of operation- (not more than 3 months) matched controls per case from our computerized database. We collected the data on these 75 patients from the prospectively recorded database and by chart review. Results: The level of the anastomosis from the anal verge and operation-related blood transfusion were found to be independently significant anastomotic risk factors by multivariate analysis. The risk of anastomotic leakage was 5.32 times higher for an anastomosis situated less than 5cm from the anal verge (P=0.006; 95% confidence interval 1.608-17.252), and was 3.90 times higher for patients that received an operation-related blood transfusion (P=0.032; 95% confidence interval 1.120-13.207). The 95% confidence interval of the mean level of the anastomosis from the anal verge in the leakage group was 3.5-4.5cm, and the 95% confidence interval for the mean operation-related blood transfusion in the leakage group was 0.2-1.4 packed red blood cells. Conclusions: We recommend proximal diversion in patients that have an anastomosis just above the anorectal ring (3.5-4.5cm from the anal verge), or received intraoperative transfusion (more than 0.2-1.4 packed red blood cells).