title: Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management.
abstract: We investigated risk factors and prognostic implications of symptomatic anastomotic leakage after anterior resection for rectal cancer, and the influence of a diverting stoma. Our retrospective review of prospective collected data analyzed 475 patients who underwent anterior resection for rectal cancer. Uni- and multivariate analysis was made between anastomotic leakage and patient, tumor, and treatment variables, either for the overall group (n = 475) and in the midlow rectal cancer subgroup (n = 291). Overall rate of symptomatic leakage was 9 per cent (43 of 475) with no related postoperative mortality. At univariate analysis, significant factors for leak were a tumor less than 6 cm from the anal verge (13.7 vs 6.6%; P = 0.011) and intraoperative transfusions (16.9 vs 4.3%; P = 0.001). Similar results were observed in the midlow rectal cancer subgroup. At multivariate analysis, no parameter resulted in being an independent prognostic factor for risk of leakage. In patients with a leakage, a temporary enterostomy considerably reduced the need for reoperation (12.5 vs 77.8%; P < 0.0001) and the risk of a permanent stoma (18.7 vs 28.5%; P = 0.49). The incidence of anastomotic failure increases for lower tumors, whereas it is not influenced by radiotherapy. Defunctioning enterostomy does not influence the leak rate, but it mitigates clinical consequences.
authors.affiliation: Digestive Surgery Division, Department of Surgical Sciences, Catholic University, School of Medicine, Rome, Italy.
authors.forename: Antonio Pio
authors.initials: AP
authors.lastname: Tortorelli
authors.forename: Sergio
authors.initials: S
authors.lastname: Alfieri
authors.forename: Alejandro Martin
authors.initials: AM
authors.lastname: Sanchez
authors.forename: Fausto
authors.initials: F
authors.lastname: Rosa
authors.forename: Valerio
authors.initials: V
authors.lastname: Papa
authors.forename: Dario
authors.initials: D
authors.lastname: Di Miceli
authors.forename: Chiara
authors.initials: C
authors.lastname: Bellantone
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors