RISK FACTORS FOR ANASTOMOSIS LEAKAGE IN LOWER ANTERIOR RESECTION: OUR EXPERIENCE

Abstract

Introduction: Anastomotic leakage is a complication of anterior rectum resection, with an incidence up to 20%. Although there ́s no consensus about risk factors for anastomotic leakage, they can be divided into patient/disease/ surgery related. We analyze risk factors in our experience for colorectal anastomosis leakage.

Material and Methods: Retrospective review of 105 patients with rectal cancer submitted to anterior rectum resection in the General Surgery Department of a terciaty referral center from 1/1/2018 to 31/12/2019. Statistical analysis was performed using the SPSS, version 25.0.

Results: We found an anastomotic leakage incidence of 10.5%. A statistically significant association between anastomotic leakage and previous abdominal surgery and usage of intraabdominal drain was seen, and a tendency to statically significance with intraoperatively red blood cells transfusion. We didn ́t found association with age, sex, cardiovascular risk factors, use of NSAIDs, corticoids, radio chemotherapy, open or laparoscopic surgery, surgeon experience, rectum tumor location and time of surgery.

Discussion: Risk factors for anastomotic leakage vary between different studies but it is consensual that it has a multifactorial cause. As there are preoperative factors that increase the risk of anastomotic leakage, an extensive study of the patient previous to the surgery is mandatory in order to minimize the complications. Unlike current literature, we didn’t find any risk factors related to the surgery and the surgeon, and only one risk factor related to the patient (previous abdominal surgery). The association between anastomotic leak and use of pelvic drain is difficult to explain and needs additional studies.

Conclusion: In our experience previous abdominal surgery is the only risk factor for anastomotic leakage development in anterior rectum resection for rectal cancer