title: Late anastomotic leakage after low anterior resection in rectal cancer patients: clinical characteristics and predisposing factors.
abstract: OBJECTIVE
  The purpose was to examine the clinical characteristics and predisposing factors of late anastomotic leakage following low anterior resection for rectal cancer.
  
  
  METHODS
  We retrospectively evaluated the clinicopathological features of patients who experienced anastomotic leakage after low anterior resection for rectal cancer. Patients were divided into two groups according to the time to leakage: early leakage (within 30 days postoperatively) and late leakage (after 30 days postoperatively). Clinicopathological characteristics were compared between the two groups.
  
  
  RESULTS
  Anastomotic leakage occurred in 141 patients. Anastomotic leakage was diagnosed at a median of 17 (range 0-886) days postoperatively; 85 (60.3%) and 56 (39.7%) were categorized as the early and late leakage groups, respectively. Radiotherapy (hazard ratio 5.007; 95% CI 2.208-11.354; P < 0.0001) was the only significant independent predisposing factor for late leakage. Diverting stoma did not protect against late leakage. The late leakage group more frequently had the fistula type (46.4% vs. 10.6%; P < 0.001) and less frequently needed laparotomy (55.4% vs. 78.8%; P = 0.001). The rate of long-term stoma over 1 year was greater in the late leakage than the early leakage group (51.8% vs. 29.4%; P = 0.009).
  
  
  CONCLUSIONS
  Late anastomotic leakages that develop after 30 days following low anterior resection are not uncommon and may be associated with the use of radiotherapy. Late leakage should be a different entity from early leakage in terms of the type of leakage, methods of management and subsequent sequelae.
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Centre, Seoul, Korea.
authors.forename: S-B
authors.initials: SB
authors.lastname: Lim
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Centre, Seoul, Korea.
authors.forename: C S
authors.initials: CS
authors.lastname: Yu
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Centre, Seoul, Korea.
authors.forename: C W
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Centre, Seoul, Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Centre, Seoul, Korea.
authors.forename: I J
authors.initials: IJ
authors.lastname: Park
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Centre, Seoul, Korea.
authors.forename: J C
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D004766:Enterostomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011184:Postoperative Period; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Anastomotic leakage; late leakage; low anterior resection of the rectum