title: Outcomes based on risk assessment of anastomotic leakage after rectal cancer surgery.
abstract: OBJECTIVE
  Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates, and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection for rectal cancer with a double stapling technique.
  
  
  METHODS
  Data for 460 patients who underwent primary anterior resection with a double stapling technique for rectal carcinoma at a single institution from 2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation. Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according to ICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logistic regression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysed using the Cox regression method.
  
  
  RESULTS
  AL was noted in 35 (7.6%) of 460 patients with rectal cancer. Median age of the patients was 65 (50-74) and 161 (35%) were male. The diagnosis of AL was made between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004), gender (p=0.007), tumor site (p<0.001), preoperative body mass index (BMI) (p<0.001), the reduction of TSGF on 5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD (p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survival of the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level BMI related (p=0.007) and advanced TNM stage related (p<0.001).
  
  
  CONCLUSIONS
  AL after anterior resection for rectal carcinoma is related to advanced age, low tumor site, male sex, high preoperative BMI, low pH value of pelvic drainage on POD 3 and a significant reduction of TSGF on POD 5. In addition to their high risk of immediate postoperative morbidity and mortality, AL, worse physical status, severe obesity and advanced TNM stage have similarly negative impact on survival.
authors.affiliation: Breast Cancer Center, the Affiliated Jiangsu Cancer Hospital of Nanjing Medical University and Jiangsu Institute of Cancer Research, Nanjing, China E-mail : huangxinen06@aliyun.com, beicheng_sun@126.com.
authors.forename: Jian-Ping
authors.initials: JP
authors.lastname: Gong
authors.forename: Liu
authors.initials: L
authors.lastname: Yang
authors.forename: Xin-En
authors.initials: XE
authors.lastname: Huang
authors.forename: Bei-Cheng
authors.initials: BC
authors.lastname: Sun
authors.forename: Jian-Nong
authors.initials: JN
authors.lastname: Zhou
authors.forename: Dong-Sheng
authors.initials: DS
authors.lastname: Yu
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.forename: Dong-Zheng
authors.initials: DZ
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Guan
authors.forename: Dong-Feng
authors.initials: DF
authors.lastname: Wang
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate