[Multivariate analysis of risk factors associated with dehiscence of colorectal anastomosis after anterior or lower anterior resection for sigmoid or rectal cancer].
BACKGROUND
Clinical anastomotic leakage remains a major problem after anterior or low anterior resection for rectal or sigmoid cancer.


OBJECTIVE
To analyze risk factors associated with this complication.


METHODS
From January 1992 to December 2000, 232 anterior or low anterior resections were performed. An univariate and multivariate analysis were performed as to find the risk factors.


RESULTS
There were 122 females and 110 males, mean age was 58.5 +/- 14.1. Tumors were located as follows: low third (n = 10), middle third (n = 104), upper third (n = 52) and sigmoid (n = 66). Ninety-two patients received preoperative radiotherapy +/- chemotherapy. Twenty-six (11.6%) had diabetes mellitus, 52 (22.4%) hypertension and 31 (13.4%) mixed cardiopathy. Forty-six patients (19.8%) had > 90% of tumor obstruction. Mean levels of serum albumin and lymphocytes were 3.7 +/- .62 g/L y de 2,026 +/- 1,576/mm3, respectively. Tumors mean distance from the anal verge was 10.2 +/- 6.7 cm. Colorectal anastomoses were performed with the following techniques: double stapled (n = 92), single stapled (n = 85) and manual (n = 55). Multivisceral resection was performed in 29 patients (12.5%); a diverting colostomy was performed in 54 patients (23.2%). Mean intraoperative haemorrhage was 505.3 +/- 393.5 mL. Mean operative time was 267.4 +/- 83 min. Sixty patients (27.2%) received blood transfusion. Mean tumor size was 4.8 +/- 2.6 cm. Tumor stage was as follows: T0-, T2, N0 (n = 60), T3, T4, N0 (n = 103), any T, N+ (n = 55) y T3-4, N+, M+ (n = 14). Nineteen patients (8.1%) developed clinical anastomotic leakage. No operative mortality was observed. Adverse risk factors for clinical anastomotic leakage were: gender (male), preoperative albumin levels < 3 g/L, preoperative tumor obstruction (> 90%) and distance of the anastomosis from the anal verge (< 7 cm).


CONCLUSIONS
In patients with these adverse risk factors a diverting colostomy or ileostomy should be performed, as to avoid fecal peritonitis.
Luna-Pérez
Pedro
P
Servicio de Colon y Recto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F. lunapp@infosel.net.mx
Rodríguez-Ramírez
Saúl E
SE
Gutiérrez de la Barrera
Marcos
M
Labastida
Sonia
S
D000714:Anastomosis, Surgical / Q000009:adverse effects; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012811:Sigmoid Neoplasms / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000453:epidemiology*