Risk factors for symptomatic anastomotic leakage after low anterior resection for rectal cancer with 30 Gy/10 f/2 w preoperative radiotherapy.

OBJECTIVE

This retrospective study was designed to analyze the risk factors for symptomatic leakage after low anterior resection (LAR) for patients with rectal cancer who received 30 Gy/10 f/2 w preoperative radiotherapy.

METHODS

From April 2002 to December 2008, a total of 223 patients with mid-low rectal cancer received 30 Gy/10 f/2 w preoperative radiotherapy and underwent LAR. Six patients were excluded for positive air test, incomplete anastomotic rings, or other major adverse intraoperative events. In the 217 patients with satisfactory anastomoses, 15 probably factors relating to anastomotic leakage were recorded and statistically analyzed.

RESULTS

The median patient age was 57 years, and 48% were women. The median level of anastomosis was 6 cm, median operating time was 130 minutes, and intraoperative blood loss was 200 ml. The symptomatic leakage rate was 11.5% (25/217). Multivariable analysis demonstrated that male gender (odds ratio (OR) = 2.63; p = 0.0474), level of anastomosis < or =4 cm (OR = 8.80; p = 0.038), no defunctioning stoma (OR = 3.80; p = 0.038), and blood loss >200 ml (OR = 3.32; p = 0.080) were the independent risk factors for anastomotic leakage.

CONCLUSIONS

For patients with rectal cancer treated with preoperative radiotherapy and low anterior resection, the risk factors for anastomotic leakage are male gender, lack of defunctioning stoma, level of anastomosis < or =4 cm, and blood loss >200 ml. A defunctioning stoma can decrease the occurrence of symptomatic anastomotic leakage and should be routinely performed in all low anterior resections after 30 Gy/10 f/2 w preoperative radiotherapy.