Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian Society of Colorectal Surgery.
BACKGROUND
The aim of the survey was to assess the incidence of anastomotic leaks (AL) and to identify risk factors predicting incidence and gravity of AL after low anterior resection (LAR) for rectal cancer performed by colorectal surgeons of the Italian Society of Colorectal Surgery (SICCR).


METHODS
Information about patients with rectal cancers less than 12 cm from the anal verge who underwent LAR during 2005 was collected retrospectively. AL was classified as grade I to IV according to gravity. Fifteen clinical variables were examined by univariate and multivariate analyses. Further analysis was conducted on patients with AL to identify factors correlated with gravity.


RESULTS
There were 520 patients representing 64% of LAR for rectal cancer performed by SICCR members. The overall rate of AL was 15.2%. Mortality was 2.7% including 0.6% from AL. The incidence of AL was correlated with higher age (p<0.05), lower (<20 per year) centre case volume (p<0.05), obesity (p<0.05), malnutrition (p<0.01) and intraoperative contamination (p<0.05), and was lower in patients with a colonic J-pouch reservoir (p<0.05). In the multivariate analysis age, malnutrition and intraoperative contamination were independent predictors. The only predictor of severe (grade III/IV) AL was alcohol/smoking habits (p<0.05) while the absence of a diverting stoma was borderline significant (p<0.07).


CONCLUSIONS
Our retrospective survey identified several risk factors for AL. This survey was a necessary step to construct prospective interventional studies and to establish benchmark standards for outcome studies.
Department of Clinical Physiopathology AOU Careggi, University of Florence, Via Morgagni 85, I-50134 Florence, Italy. corrado.asteria@libero.it
C R
CR
Asteria
G
G
Gagliardi
S
S
Pucciarelli
G
G
Romano
A
A
Infantino
F
F
La Torre
F
F
Tonelli
F
F
Martin
C
C
Pulica
V
V
Ripetti
G
G
Diana
G
G
Amicucci
M
M
Carlini
A
A
Sommariva
G
G
Vinciguerra
D B
DB
Poddie
A
A
Amato
R
R
Bassi
R
R
Galleano
E
E
Veronese
S
S
Mancini
G
G
Pescio
G L
GL
Occelli
S
S
Bracchitta
M
M
Castagnola
T
T
Pontillo
G
G
Cimmino
U
U
Prati
R
R
Vincenti
D000368:Aged; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome