Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors

Table 1 Clinical, demographic and pathological characteristics in 583 rectal cancer patients

	Patients, n	%
Age, yr
< 65	242	41.5
≥ 65	341	58.5
Sex
M	301	51.6
F	282	48.4
Albumin, g/dL
< 3.5	117	20.0
≥ 3.5	466	80.0
CEA, ng/mL
< 5	247	42.4
≥ 5	336	57.6
Hemoglobin, g/dL
< 10	291	49.9
≥ 10	292	50.1
Prognostic nutritional index points
< 40	130	22.3
≥ 40	453	77.7
Concomitant diseases
Yes	297	50.9
No	287	49.1
Weight loss
Yes	98	16.8
No	485	83.2
Smoking habits
Yes	227	38.9
No	356	61.1
Alcohol habits
Yes	75	12.9
No	508	87.1
Bowel preparation
Complete/adequate	361	61.9
Poor	222	38.1
Blood transfusions
No	321	55.1
≥ 1 Unit	262	44.9
Neoadjuvant treatment
Yes	393	67.4
No	190	32.6
Type of approach
Open	447	76.7
Laparoscopy	136	23.3
Location of anastomosis
Medium rectum	288	49.4
Low rectum	295	50.6
Mesorectal excision
Total	311	53.3
Partial	272	46.6
Site of vascular ligation
Inferior mesenteric artery	277	47.5
Superior hemorrhoidal artery	306	52.5
No. stapler cartridges used
1	351	60.2
> 1	232	39.8
Diameter of circular stapler in mm
25	128	21.9
28	455	78.1
Diverting ileostomy
Present	297	51.0
Absent	286	49.0
Transanastomotic decompression tube
Present	196	33.6
Absent	387	66.4
T status
T1	73	12.5
T2	104	17.8
T3	306	52.5
T4	100	17.2
N status
N+	321	55.1
N-	262	44.9
Stage
I	122	20.9
II	185	31.7
III	276	47.4

CEA: Carcinoembryonic antigen; M: Male; F: Female.

Table 2 Clinical and demographic characteristics, n (%)

Patients, n	Leakage		P value
	Absent, n = 522	Present, n = 61
Mean age, yr	59.7 ± 17.2	68.2 ± 10.7	0.0002
Age, yr
< 65	223 (92.2)	19 (7.8)	0.09
≥ 65	299 (87.7)	42 (12.3)
Sex
M	263 (87.4)	38 (12.6)	0.08
F	259 (91.9)	23 (8.1)
Albumin, g/dL
< 3.5	117 (84.8)	21 (15.2)	0.006
≥ 3.5	466 (92.1)	40 (7.9)
CEA, ng/mL
< 5	247 (89.5)	29 (10.5)	0.4
≥ 5	336 (91.3)	32 (8.7)
Hemoglobin, g/dL
< 10	291 (88.2)	39 (11.8)	0.02
≥ 10	292 (93.0)	22 (7.0)
Prognostic nutritional index points
< 40	130 (81.8)	29 (18.2)	0.0001
≥ 40	453 (93.4)	32 (6.6)
Concomitant diseases
Yes	259 (87.6)	37 (12.4)	0.1
No	263 (91.7)	24 (8.3)
Weight loss
Yes	81 (82.7)	17 (17.3)	0.01
No	441 (90.9)	44 (9.1)
Smoking habits
Yes	201 (88.6)	26 (11.4)	0.5
No	321 (90.2)	35 (9.8)
Alcohol habits
Yes	71 (94.7)	4 (5.3)	0.1
No	451(88.8)	57 (11.2)
Bowel preparation
Complete/adequate	336 (93.1)	25 (6.9)	0.0007
Poor	186 (83.8)	36 (16.2)
Blood transfusions
No	299 (93.2)	22 (6.8)	0.002
≥ 1 unit	223 (85.2)	39 (14.8)
Mean tumor distance from anal verge in mm	89.0 ± 21.0	71.0 ± 32.0	0.0001
Neoadjuvant treatment
Yes	349 (88.8)	44 (11.2)	0.4
No	173 (91.1)	17 (8.9)
Mean hospital stays in d	7.0 ± 2.1	29.2 ± 13.4	0.0001

CEA: Carcinoembryonic antigen; F: Female; M: Male.

Table 3 Treatment related variables, n (%)

Patients, n	Leakage		P value
	Absent, n = 522	Present, n = 61
Mean operative time, min	115.0 ± 47.8	186.0 ± 40.2	0.0001
Intraoperative blood loss, mL	175.5 ± 45.0	365.0 ± 50.0	0.0001
Type of approach
Open	401 (89.8)	46 (10.2)	0.8
Laparoscopy	121 (89.0)	15 (11.0)
Location of anastomosis
Medium rectum	268 (93.1)	20 (6.9)	0.006
Low rectum	254 (86.1)	41 (13.9)
Mesorectal excision
Total	270 (86.9)	41 (13.1)	0.02
Partial	252 (92.7)	20 (7.3)
Site of vascular ligation
Inferior mesenteric artery	238 (86.0)	39 (14.0)	0.009
Superior hemorrhoidal artery	284 (92.9)	22 (7.1)
No. stapler cartridges used
1	332 (94.6)	19 (5.4)	0.0001
> 1	190 (81.9)	42 (18.1)
Diameter of circular stapler, mm
25	121 (94.6)	7 (5.4)	0.03
28	401 (88.2)	54 (11.8)
Diverting ileostomy
Present	267 (89.9)	30 (10.1)	0.7
Absent	255 (89.2)	31 (10.8)
Transanastomotic decompression tube
Present	184 (93.9)	12 (6.1)	0.01
Absent	338 (87.4)	49 (12.6)

Table 4 Staging and pathological data, n (%)

Patients, n	Leakage		P value
	Absent, n = 522	Present, n = 61
Mean tumor diameter, mm	39.0 ± 21.1	47.9 ± 16.1	0.001
T status
T1-2	177 (94.2)	11 (5.8)	0.02
T3-4	406 (89.0)	50 (11.0)
N status
N+	279 (86.9)	42 (13.1)	0.02
N-	243 (92.8)	19 (7.2)
Stage
I	115 (94.3)	7 (5.7)	0.011
II	171 (92.4)	14 (7.6)	0.022
III	236 (85.5)	40 (14.5)

¹Stage I vs Stage III.

²Stage II vs Stage III.

Table 5 Mortality and morbidity in-hospital or 30 d, n (%)

Patients, n	Leakage		P value
	Absent, n = 522	Present, n = 61
Mortality	2 (40.0)	3 (60.0)	0.009
Reoperation	0	35 (100)	0.0001
Peritonitis/abdominal sepsis	1 (4.6)1	21 (95.4)	0.0001
Pelvic sepsis	2 (3.7)1	53 (96.3)	0.0001
Wound dehiscence	3 (42.9)	4 (57.1)	0.003
Wound infection	10 (52.8)	7 (41.2)	0.0008
Urinary infection	10 (76.9)	3 (23.1)	0.1
Urinary retention2	3 (33.4)	6 (66.6)	0.0001
Pneumonia	3 (60.0)	2 (40.0)	0.08

¹Due to blood collections with secondary infection from contamination during primary surgery in patients without anastomotic leakage.

²Catheter at discharge.