Assessment of Risk Factors for Anastomotic Leakage After Resection for Rectal Cancers

Background: Anastomotic leakage(AL) after colorectal cancer surgery is encountered frequently, which is considered one of the most potentially lethal complications. It affects the quality of life and increases hospital costs, so detecting risk factors for leakage might have a beneficial effect on reducing the occurrence and improving the final outcome. Objective: This study aimed to investigate risk factors associated with the development of leakage. Patients and Methods: An analytic retrospective study was conducted in patients with a proven diagnosis of rectal cancer. They were selected from the Department of General Surgery, Tishreen University Hospital in Lattakia, Syria, between January 2017 and January 2021. Patients were divided into two groups: group 1 included patients who developed anastomotic leakage(11 patients), and group 2 included patients without leakage (67 patients). Risk factors for AL and mortality were compared between the two groups. Results: The population of 78 patients was predominantly males (61.5%), with a mean age of 61.12±7.3 years. The most frequent age group was older than 60 years (70.5%), with the presence of type 2 diabetes mellitus(T2DM) in 30.8%. Stage III represented the most frequent grade of the tumor (42.3%), followed by stage II and I (57.7%), with the presence of a history of chemotherapy in 15.4% of the patients. The rate of AL was 14.1%, which was divided into two groups: early in 9 cases(11.5%) and late in 2 cases(2.6%). Prevalence of AL was significantly higher in males(18.8% versus 6.7%,p:0.001), patients with BMI >30(30% versus 11.8%,p:0.008), presence of chemotherapy before surgery(25% versus 12.1%,p:0.02), decreased levels of albumin(30% versus 8.6%,p:0.0001), tumors with distance from anal verge<5 cm(31.8% versus 7.1%,p:0.0001), and in cases of blood transfusion(19.4% versus 9.5%,p:0.04). The mortality rate was higher in the presence of leakage(27.3% versus 4.5%,p:0.004), hypoalbuminemia (RR 3.9), longer duration of surgery (RR 2.4), male gender (RR 2.01) and presence of obesity (RR 3.1)were independent factors that associated significantly with the risk for progression of AL. Conclusion: The current study demonstrated an important prevalence of AL in our hospital, and the presence of hypoalbuminemia, longer duration of surgery, male gender, and obesity are all warning flags that may predispose to leakage after colorectal surgery.