Predictors of anastomotic leak after anterior rectal resections for localized malignant neoplasms

Abstract

Background:. Anastomotic leak (AL) is the most serious complication in rectal surgery. Predicting and preventing AL remains an urgent task. The purpose of the study is to analyze the 17-year experience of the Federal State Budgetary Institution Federal Research Center FMBA of Russia in performing anterior resection of the rectum in patients with cancer of the rectum and rectosigmoid junction and to establish risk factors for the development of AL. Methods. The results of treatment of 492 patients who were treated in 2006-2022 were studied. anterior resection of the rectum was performed. 21 patients developed AL. A retrospective comparison of the characteristics of two groups of patients was carried out: those with a smooth course of the postoperative period and those with the development of AL. Results. Reliable risk factors for the development of AL were identified and, based on statistical analysis, a prognostic scoring model was proposed: smoking (1 point), type 2 diabetes mellitus (1 point), preoperative chemotherapy (1 point), blood loss over 50 ml (2 points), preoperative radiation therapy (3 points), and the location of the colorectal anastomosis at a distance of up to 5 cm from the anus (4 points). The sensitivity of the model on the training set with 8 points or more was 85.6%, with a specificity above 97.4%. Conclusion. The following tactics are proposed: if there are 4 points and above, we form a preventive intestinal stoma; if there are 1-3 points, we install a transanal drainage. Complete abandonment of these two preventive measures is possible only if the patient does not have any of the listed risk factors for the development of anastomotic leak.