Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer.
BACKGROUND
Anastomosis leakage is a major complication of rectal surgery. The aim of this study was to identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on long-term prognosis and disease-free survival and overall survival in rectal cancer patients.


METHODS
Consecutive patients who underwent rectal resection with primary anastomosis below the pelvic peritoneal reflexion for rectal cancer between October 1996 to February 2006 were included.


RESULTS
Anastomosis leakage after LAR occurred in 51 patients (4.0%). The median time to leakage was 4 days (range = 2-30 days). In univariate analysis, gender, level of anastomosis less than 4 cm, preoperative concomitant chemoradiation (CCRT), and length of operation greater than 120 min were significantly associated with anastomosis leakage. In a multivariate analysis, gender (p = 0.041; relative risk = 2.007; 95% CI = 1.030-3.912) and preoperative CCRT (p = 0.003; relative risk = 2.861; 95% CI = 1.417-5.778) were identified as independent prognostic factors. The overall survival of the nonleakage group and the leakage group was 80.2% and 64.9%, respectively (p = 0.170). The 5-year disease-free survival rates were not significantly different between the nonleakage and leakage groups (78.1% vs. 65.9%, p = 0.166).


CONCLUSIONS
The incidence of anastomotic leakage after low anterior resection is relatively low. Male gender and preoperative CCRT were associated with increased risk for anastomotic leakage after rectal cancer surgery. No effect of anastomosis leakage on local recurrence was found in this series.
Lee
Won-Suk
WS
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea.
Yun
Seong Hyeon
SH
Roh
Young-Nam
YN
Yun
Hae-Ran
HR
Lee
Woo Yong
WY
Cho
Yong Beom
YB
Chun
Ho-Kyung
HK
D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D010538:Peritonitis / Q000209:etiology*; D011379:Prognosis; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome