title: The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients.
abstract: BACKGROUND
  Anastomotic complications after low anterior resection are associated with perianastomotic ischemia. Smoking is one of the main causes of microvascular disease that is correlated with tissue ischemia. The purpose of the present study was to assess the impact of smoking on anastomotic complications after low anterior resection in rectal cancer patients.
  
  
  METHODS
  Between January 2005 and December 2008, 412 patients underwent low anterior resection for rectal cancers by a single surgeon at Seoul National University Hospital. Excluded from this series were 197 patients with postoperative radiation therapy, cancers that were located above 10 cm from the anal verge, or lack of medical records, and the remaining 215 patients were included for analysis. Significant variables in the univariate analysis were subsequently subject to multivariate analysis for identification of risk factors for complications.
  
  
  RESULTS
  The rate of anastomotic complications was 10.7% (23 of 215 patients). Univariate analysis showed that male gender, body mass index higher than 25 kg/m(2), smoking history, smoking amount, type of operation, and presence of a protective stoma were associated with anastomotic complications. In multivariate analysis, a history of heavy smoking was a significant risk factor for anastomotic complications.
  
  
  CONCLUSIONS
  A history of heavy smoking (more than 40 pack-years) is an independently significant risk factor for anastomotic complications after low anterior resection in rectal cancer patients.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, 101 Daehang-no, Jongno-gu, Seoul, 110-774, Korea, Republic of Korea.
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Kim
authors.forename: Rumi
authors.initials: R
authors.lastname: Shin
authors.forename: Heung-Kwon
authors.initials: HK
authors.lastname: Oh
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Park
authors.forename: Seung-Yong
authors.initials: SY
authors.lastname: Jeong
authors.forename: Jae-Gahb
authors.initials: JG
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000209:etiology*; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*