Risk factors for anastomotic leakage after rectal cancer surgery

Abstract

Anastomotic leakage is one of the common complications after rectal cancer surgery. Advances in the field of rectal surgery, such as introduction of total mesorectal excision, double-stapling reconstruction techniques, and minimally invasive surgery have improved oncologic outcomes and resulted in more favorable functional results, with a greater proportion of patients undergoing sphincter-preserving surgeries. Despite technical improvements, the incidence of anastomotic leakage has not decreased significantly. The incidence of anastomotic leakage is related to many factors, including patient-related factors, such as male sex, obesity, low score of nutrition risk screening, and III(-IIIII( grade of ASA grading; disease-related factors, such as lower tumor location, tumor diameter >3 cm, preoperative chemoradiotherapy and comorbidity; surgery-related factors, such as open or laparoscopic surgery, blood supply of anastomosis, tension of anastomosis, preventive stoma, duration of surgery, intraoperative blood loss, intraoperative events, and contamination, as well as selection and use of anastomotic device. Fully understanding the risk factors of anastomotic leakage are very important for reducing the occurrence of anastomotic leakage. For patients with risk factors, appropriate preventive measures should be implemented timely to reduce the risk of anastomotic leakage.