title: Risk factors for anastomotic leakage after resection for rectal cancer.
abstract: OBJECTIVE
  The aim of this study was to identify risk factors for anastomotic leakage in patients that have received a resection for rectal cancer.
  
  
  METHODS
  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).
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Korea.
authors.forename: Min Ro
authors.initials: MR
authors.lastname: Lee
authors.forename: Chang Won
authors.initials: CW
authors.lastname: Hong
authors.forename: Sang Nam
authors.initials: SN
authors.lastname: Yoon
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: Kyu Joo
authors.initials: KJ
authors.lastname: Park
authors.forename: Jae-Gahb
authors.initials: JG
authors.lastname: Park
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D003082:Colectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology