The risk of anastomotic leakage after anterior resection: retrospective analysis of 501 rectal cancer patients operated without protective stoma.

BACKGROUND: The aim of this study was to verify the accuracy of the existing scoring system for the assessment of anastomotic leakage risk after anterior resection and to identify additional risk factors that were not included in this classification.

METHODS: The study included 501 consecutive rectal cancer patients who underwent anterior resection without formation of protective stoma. The risk for anastomotic leakage was determined using a previously proposed scoring system based on three factors: male sex, intraoperative blood loss and level of anastomosis.

RESULTS: Symptomatic leakage occurred in 12.2% (61/501) of our patients. Lower level of anastomosis (P<0.001) and longer duration of surgery (P=0.018) were identified as independent risk factors for the leakage. Anastomotic dehiscence occurred in 7.3% (24/327), 20.1% (29/144) and 26.7% (8/30) of patients at low, intermediate and high risk of leakage according to the previously proposed scoring system. No differences were found in the leakage rates of patients from the intermediate and high risk groups (20.1% vs. 26.7%, P=0.427, RR=0.755 (95% CI: 0.384-1.486).

CONCLUSIONS: The new scoring system is necessary for the identification of patients at increased risk of anastomotic leakage after anterior resection.