title: Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection.
abstract: OBJECTIVE
  To examine modifiable risk factors for anastomotic leak in patients undergoing low anterior resection.
  
  
  METHODS
  In total 233 patients undergoing low anterior resection for benign and malignant disease over a 10-year period at a single surgical unit were identified from a prospective database. The relationships between anastomotic leak and 17 variables were examined, including patient demographics, operative technique, tumour pathology, preoperative physiological function and smoking status.
  
  
  RESULTS
  The majority (91%) of operations were carried out for rectal cancers, and 24 procedures (10%) were performed with laparoscopic assistance. The overall anastomotic leak rate was 14% (33/233). Patients with anastomotic leak had higher 30-day mortality (6%vs 1%, P<0.05) and stayed significantly longer in hospital (median 23 vs 10 days, P<0.001). On multivariate analysis, current smokers (OR 3.68, 95% CI 1.38-9.82, P=0.009) and patients with evidence of metastatic malignant disease (OR 3.43, 95% CI 1.29-9.13, P=.013) were at increased risk of anastomotic leak.
  
  
  CONCLUSIONS
  Smoking and the presence of metastatic disease are major risk factors for the development of anastomotic leak following low anterior resection.
authors.affiliation: Department of Surgical Science, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. colinrichards@nhs.net
authors.forename: C H
authors.initials: CH
authors.lastname: Richards
authors.forename: V
authors.initials: V
authors.lastname: Campbell
authors.forename: C
authors.initials: C
authors.lastname: Ho
authors.forename: J
authors.initials: J
authors.lastname: Hayes
authors.forename: T
authors.initials: T
authors.lastname: Elliott
authors.forename: M
authors.initials: M
authors.lastname: Thompson-Fawcett
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology*; D003110:Colonic Neoplasms / Q000473:pathology* / Q000601:surgery*; D016001:Confidence Intervals; D004239:Diverticulitis, Colonic / Q000601:surgery; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D055815:Young Adult