title: Risk factors causing structural sequelae after anastomotic leakage in mid to low rectal cancer.
abstract: OBJECTIVE
  To investigate the risk factors causing structural sequelae after anastomotic leakage in patients with mid to low rectal cancer.
  
  
  METHODS
  Prospectively collected data of consecutive subjects who had anastomotic leakage after surgical resection for rectal cancer from March 2006 to May 2013 at Korea University Anam Hospital were retrospectively analyzed. Two subgroup analyses were performed. The patients were initially divided into the sequelae (stricture, fistula, or sinus) and no sequelae groups and then divided into the permanent stoma (PS) and no PS groups. Univariate and multivariate analyses were performed to identify the risk factors of structural sequelae after anastomotic leakage.
  
  
  RESULTS
  Structural sequelae after anastomotic leakage were identified in 29 patients (39.7%). Multivariate analysis revealed that diversion ileostomy at the first operation increases the risk of structural sequelae [odds ratio (OR) = 6.741; P = 0.017]. Fourteen patients (17.7%) had permanent stoma during the follow-up period (median, 37 mo). Multivariate analysis showed that the tumor level from the dentate line was associated with the risk of permanent stoma (OR = 0.751; P = 0.045).
  
  
  CONCLUSIONS
  Diversion ileostomy at the first operation increased the risk of structural sequelae of the anastomosis, while lower tumor location was associated with the risk of permanent stoma in the management of anastomotic leakage.
authors.affiliation: Woong Bae Ji, Jung Myun Kwak, Jin Kim, Jun Won Um, Seon Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Woong Bae
authors.initials: WB
authors.lastname: Ji
authors.affiliation: Woong Bae Ji, Jung Myun Kwak, Jin Kim, Jun Won Um, Seon Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Jung Myun
authors.initials: JM
authors.lastname: Kwak
authors.affiliation: Woong Bae Ji, Jung Myun Kwak, Jin Kim, Jun Won Um, Seon Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.affiliation: Woong Bae Ji, Jung Myun Kwak, Jin Kim, Jun Won Um, Seon Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Jun Won
authors.initials: JW
authors.lastname: Um
authors.affiliation: Woong Bae Ji, Jung Myun Kwak, Jin Kim, Jun Won Um, Seon Hahn Kim, Department of Surgery, Korea University College of Medicine, Seoul 136-705, South Korea.
authors.forename: Seon Hahn
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Anastomotic leakage; Anastomotic leakage fate; Leakage sequelae; Permanent stoma; rectal cancer