Risk Factors for Anastomotic Leakage after Rectal Surgery in Locally Advanced Rectal Cancer

Objective: To identify the risk factors for anastomosis leakage (AL) after rectal resection for locally advanced rectal cancers (LARCs) treated with neoadjuvant chemoradiation (nCRT). Material and Methods: A retrospective risk factor study was conducted in LARC patients who received nCRT in Hatyai Hospital from September 2014 to September 2023. The patients were classified into two groups, AL and no anastomotic leak (No-AL) groups. The variables analyzed included age, gender, body mass index (BMI), American Society of Anesthesiologists classification score (ASA), history of significant weight loss, tumor level, time interval between nCRT and surgery, the number of staples, surgical approach, estimated blood loss (EBL), packed red cell (PRC) transfusions, operative time, diverting ostomy, and type of surgery. These predictive factors were analyzed by univariable and multivariable logistic regression. Results: One hundred and seventeen patients were included in the study. The AL rate was 8.5% and the 30-day mortality rate was zero. The study found that BMI, time interval, EBL, and PRC transfusions were associated with a significantly increased AL risk under univariable analysis. In the multivariable analysis, four factors were identified as independent risk factors for AL: BMI less than 18 kg/m2, time interval more than 11 weeks, needing packed red cells blood transfusion, and operative time more than 400 minutes. Conclusion: Diverting stoma can reduce AL consequences but does not reduce its incidence. Diverting stoma should be considered in locally advanced rectal cancer treated with neoadjuvant chemoradiation patients with the risk factors noted above-BMI less than 18 kg/m2, time interval longer than 11 weeks, needing PRC transfusion, or operative time more than 400 minutes.