Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13321
Peer-review started: October 13, 2022
First decision: November 6, 2022
Revised: November 8, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Anastomotic leakage (AL) after restorative surgery for rectal cancer (RC) is associated with significant morbidity and mortality.
To ascertain the risk factors by examining cases of AL in rectal surgery in this retrospective cohort study.
To identify risk factors for AL, a review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated.
The incidence of AL was 10.4%, with a mean time interval of 6.2 ± 2.1 d. Overall mortality was 0.8%. Mortality was higher in patients with AL (4.9%) than in patients without leak (0.4%, P = 0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index < 40 points, tumor diameter and intraoperative blood loss were identified as risk factors for AL. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to AL in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube significantly did.
Clinical, surgical and pathological factors are associated with an increased risk of AL. It adversely affects the morbidity and mortality of RC patients.
Core Tip: Anastomotic leakage (AL) after rectal cancer surgery is associated with significant morbidity and mortality. A review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis in a 15-year period was performed. The overall incidence of AL was 10.4%. Mortality was higher in patients with AL than in patients without leak. Prognostic nutritional index < 40 points and intraoperative blood loss were identified as risk factors for AL. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler and level of vascular section were also correlated to AL in our patients.