title: Anastomotic leakage after anterior resection for rectal cancer: risk factors.
abstract: OBJECTIVE
  The study aimed to identify risk factors for clinical anastomotic leakage (AL) after anterior resection for rectal cancer in a consecutive national cohort.
  
  
  METHODS
  All patients with an initial first diagnosis of colorectal adenocarcinoma were prospectively registered in a national database. The register included 1495 patients who had had a curative anterior resection between May 2001 and December 2004. The association of a number of patient- and procedure-related factors with clinical AL after anterior resection was analysed in a cohort design.
  
  
  RESULTS
  Anastomotic leakages occurred in 163 (11%) patients. In a multivariate analysis, the risk of AL was significantly increased in patients with tumours located below 10 cm from the anal verge if no faecal diversion was undertaken (OR 5.37 5 cm (tumour level from anal verge), 95% CI 2.10-13.7, OR 3.57 7 cm, CI 1.81-7.07 and OR 1.96 10 cm, CI 1.22-3.10), in male patients (OR 2.36, CI 1.18-4.71), in smokers (OR 1.88, CI 1.02-3.46), and perioperative bleeding (OR 1.05 for intervals of 100 ml blood loss, CI 1.02-1.07).
  
  
  CONCLUSIONS
  Anastomotic leakage after anterior resection for low rectal tumours is related to the level, male gender, smoking and perioperative bleeding. Faecal diversion is advisable after total mesorectal excision of low rectal tumours in order to prevent AL.
authors.affiliation: Department of Surgery, Bispebjerg University Hospital, University of Copenhagen, Denmark. anders.bertelsen@dadlnet.dk
authors.forename: C A
authors.initials: CA
authors.lastname: Bertelsen
authors.forename: A H
authors.initials: AH
authors.lastname: Andreasen
authors.forename: T
authors.initials: T
authors.lastname: Jørgensen
authors.forename: H
authors.initials: H
authors.lastname: Harling
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D016063:Blood Loss, Surgical; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D012004:Rectal Neoplasms / Q000601:surgery*; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking