Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer.
OBJECTIVE
To identify the risk, the host-related prognostic factors and their predictive value for anastomotic leakage after colorectal resections following cancer.


METHODS
993 patients who underwent large bowel resection and primary anastomosis above 12 centimeters from the anal verge, without a temporary or permanent stoma at the Surgical Hospital No.3 (Cluj-Napoca, Romania) were retrospectively reviewed.


RESULTS
32 (3.22 percent) anastomotic leaks were confirmed. Univariate analysis showed that the preoperative variables significantly associated with anastomotic leakage included: weight loss, smoking, cardiovascular disease, lung disease, hypoproteinemia, diabetes, anemia, leukocytosis, presence of two or more underlying diseases. Alcohol use, cerebrovascular disease, bowel preparation, type of anastomosis, tumor location, stage and histology were not significant variables. Hypoproteinemia (total serum protein level < or = 6 g/dl) and anemia (serum hemoglobin level < or = 11 g/dl) remained significant in the logistic regression model. The prognostic role of serum hemoglobin and proteins for the anastomotic leak was assessed using ROC curve analysis. For the cut-off value of serum protein level = 5.5 g/dl, a sensitivity of 61.6 percent and a specificity of 84.2 percent were calculated. The area under the curve was 0.703 (p= 0.0024). The area under the curve for serum hemoglobin was 0.616 (p=0.028). A sensitivity of 64.0 percent and a specificity of 64.7 per cent were obtained for a cut-off value of 9.4 g/dl. CONCLUSION. A serum protein level lower than 5.5 g/dl and serum hemoglobin lower than 9.4 g/dl could be considered as host-related predictive markers for anastomotic leak in large bowel resections for cancer.
Department of Surgical Disciplines, University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Surgery Clinic, Croitorilor Str 19-21, 400162 Cluj-Napoca, Romania. dr_cornel_iancu@yahoo.com
Cornel
C
Iancu
Lucian C
LC
Mocan
Dana
D
Todea-Iancu
Teodora
T
Mocan
Iurie
I
Acalovschi
Daniela
D
Ionescu
Florin V
FV
Zaharie
Gelu
G
Osian
Cosmin I
CI
Puia
Valentin
V
Muntean
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications; D001798:Blood Proteins / Q000032:analysis; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007019:Hypoproteinemia / Q000150:complications; D007420:Intestine, Large / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology*
D001798:Blood Proteins; D006454:Hemoglobins