Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer

• Published in: International journal of colorectal disease Vol. 22; no. 8; pp. 919 - 927
• Main Authors: KRUSCHEWSKI, Martin, RIEGER, Hayo, POHLEN, Uwe, HOTZ, Hubert G, BUHR, Heinz J
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.08.2007; Berlin Springer Nature B.V
• Subjects: Aged; Anastomosis, Surgical - mortality; Biological and medical sciences; Coronary Disease - complications; Coronary Disease - mortality; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - mortality; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Odds Ratio; Population Surveillance; Postoperative Complications - etiology; Postoperative Complications - mortality; Prospective Studies; Rectal Neoplasms - mortality; Rectal Neoplasms - surgery; Risk Assessment; Risk Factors; Smoking - adverse effects; Smoking - mortality; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Treatment Outcome; Tumors; Postoperative; Rectal disease; Prognosis; Rectal cancer; Mortality; Colorectal cancer; Malignant tumor; Epidemiology; Colonic disease; Treatment; Surgery; Risk factor; Digestive diseases; Intestinal disease; Colorectal cancer, Anastomotic leakage; Postoperative mortality, Risk factors; Anorectal disease
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-006-0260-0

Clinical anastomotic leakage remains a major problem after anterior or low anterior resection for rectal cancer. The aim of this study was to assess the association between risk factors and anastomotic leakage and postoperative mortality. Two hundred seventy-six elective anterior or low anterior resections with anastomosis were performed and documented on-line from January 1995 to December 2004. Univariate and multivariate analyses with Bonferroni adjustment were carried out to identify relevant risk factors. The rate of anastomotic leakage was 14.9% (41 of 276 patients) with a mortality of 12.2% (5 of 41 patients). Overall mortality was 2.5% (7 of 276 patients). Multiple regression analysis showed that smokers had an increased risk of anastomotic leakage [odds ratio (OR), 6.42; 95% confidence interval (CI), 2.68-15.36] as well as patients with coronary heart disease (OR, 7.79; 95% CI, 2.52-24.08). Smokers (OR, 13.20; 95% CI, 2.48-7.24) and patients with coronary heart disease (OR, 23.46; 95% CI, 4.33-27.04) also had an increased risk of postoperative mortality in the univariate analysis as well as patients with anastomotic leakage (OR, 16.25; 95% CI, 3.04-16.92). Smoking and coronary heart disease are important risk factors for anastomotic leakage and postoperative mortality after elective resection for rectal cancer.