Factors Associated With Anastomotic Leakage After Anus-Preserving Operation For Rectal Cancer

Objective To investigate the incidence, factors and preventative methods associatedwith anastomotic leakage after anus-preserving operation for rectal cancer.Methods Clinical data were analyzed retrospectively from931patients with rectalcancer who underwent anus-preserving operation by the same surgical team betweenJanuary2000and October2012.Results The overall rate of anastomic leak was4.5%(42/931), and2.6%(8/307)with a defunctioning colostomy had leakage, compared with8.9%(34/624) withouta defunctioning colostomy. The incidence of postoperative anastomotic leakage inthe patients receiving neoadjuvant chemoradiotherapy was8.7%(12/138),compared with3.8%(30/793) for patients who had no neoadjuvantchemoradiotherapy (P=0.010). On univariate analysis, occurrence of anastomoticleakage was related with advanced age, a distance≤5cm from the tumor to the analverge, serum albumin level <35g/L before surgery, neoadjuvant chemoradiotherapy(P <0.05), and was not related with sex, BMI, the score of ASA, beingcomplicated with diabetes, ferrohemoglobin, tumor locations, cell differentiation,tumor invasion depth, tumor stages, operation method. On multivariate analysis,neoadjuvant chemoradiotherapy (OR=2.46,95%CI:1.181~5.123, P=0.016), adistance≤5cm from the tumor to the anal verge (OR=1.26,95%CI:1.149~1.457, P=0.018) and a defunctioning colostomy (OR=0.41,95%CI:0.182~0.912, P=0.029)were independently associated with anastomotic leakage.Conclusion Neoadjuvant chemoradiotherapy, a distance≤5cm from the tumor tothe anal verge, a defunctioning colostomy are independently associated withanastomotic leakage for rectal cancer patients underwent anus-preserving operation, which should be considered in perioperative decision-making defunctioningcolostomy.