World Journal of Surgery

, Volume 32, Issue 6, pp 1124–1129 | Cite as

Risk Factors and Clinical Outcome for Anastomotic Leakage After Total Mesorectal Excision for Rectal Cancer

  • Won-Suk Lee
  • Seong Hyeon Yun
  • Young-Nam Roh
  • Hae-Ran Yun
  • Woo Yong Lee
  • Yong Beom Cho
  • Ho-Kyung ChunEmail author



Anastomosis leakage is a major complication of rectal surgery. The aim of this study was to identify risk factors for anastomotic leakage after low anterior resection (LAR) in rectal cancer patients and study its impact on long-term prognosis and disease-free survival and overall survival in rectal cancer patients.


Consecutive patients who underwent rectal resection with primary anastomosis below the pelvic peritoneal reflexion for rectal cancer between October 1996 to February 2006 were included.


Anastomosis leakage after LAR occurred in 51 patients (4.0%). The median time to leakage was 4 days (range = 2–30 days). In univariate analysis, gender, level of anastomosis less than 4 cm, preoperative concomitant chemoradiation (CCRT), and length of operation greater than 120 min were significantly associated with anastomosis leakage. In a multivariate analysis, gender (p = 0.041; relative risk = 2.007; 95% CI = 1.030–3.912) and preoperative CCRT (p = 0.003; relative risk = 2.861; 95% CI = 1.417–5.778) were identified as independent prognostic factors. The overall survival of the nonleakage group and the leakage group was 80.2% and 64.9%, respectively (p = 0.170). The 5-year disease-free survival rates were not significantly different between the nonleakage and leakage groups (78.1% vs. 65.9%, p = 0.166).


The incidence of anastomotic leakage after low anterior resection is relatively low. Male gender and preoperative CCRT were associated with increased risk for anastomotic leakage after rectal cancer surgery. No effect of anastomosis leakage on local recurrence was found in this series.


Rectal Cancer Anastomotic Leakage Leakage Rate Lymphovascular Invasion Rectal Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Knight CD, Griffen FD (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710–714PubMedGoogle Scholar
  2. 2.
    Karanjia ND, Corder AP, Bearn P et al (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226PubMedCrossRefGoogle Scholar
  3. 3.
    Moran B, Heald R (2000) Anastomotic leakage after colorectal anastomosis. Semin Surg Oncol 18:244–248PubMedCrossRefGoogle Scholar
  4. 4.
    Nesbakken A, Nygaard K, Lunde OC et al (2005) Anastomotic leak following mesorectal excision for rectal cancer: true incidence and diagnostic challenges. Colorectal Dis 7:576–581PubMedCrossRefGoogle Scholar
  5. 5.
    Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging manual, 6th ed., New York: Springer-ValagGoogle Scholar
  6. 6.
    Eckmann C, Kujath P, Schiedeck TH et al (2004) Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 19:128–133PubMedCrossRefGoogle Scholar
  7. 7.
    Eriksen MT, Wibe A, Norstein J et al (2005) Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 7:51–57PubMedCrossRefGoogle Scholar
  8. 8.
    Isbister WH (2001) Anastomotic leak in colorectal surgery: a single surgeon’s experience. ANZ J Surg 71:516–520PubMedCrossRefGoogle Scholar
  9. 9.
    Kanellos I, Vasiliadis K, Angelopoulos S et al (2004) Anastomotic leakage following anterior resection for rectal cancer. Tech Coloproctol 8 Suppl 1:s79–s81PubMedCrossRefGoogle Scholar
  10. 10.
    Kruschewski M, Rieger H, Pohlen U et al (2007) Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22:919-927PubMedCrossRefGoogle Scholar
  11. 11.
    Law WI, Chu KW, Ho JW et al (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96PubMedCrossRefGoogle Scholar
  12. 12.
    Matthiessen P, Hallbook O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469PubMedCrossRefGoogle Scholar
  13. 13.
    Peeters KC, Tollenaar RA, Marijnen CA et al (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92:211–216PubMedCrossRefGoogle Scholar
  14. 14.
    Rodriguez-Ramirez SE, Uribe A, Ruiz-Garcia EB et al (2006) Risk factors for anastomotic leakage after preoperative chemoradiation therapy and low anterior resection with total mesorectal excision for locally advanced rectal cancer. Rev Invest Clin 58:204–210PubMedGoogle Scholar
  15. 15.
    Rudinskaite G, Tamelis A, Saladzinskas Z et al (2005) Risk factors for clinical anastomotic leakage following the resection of sigmoid and rectal cancer. Medicina (Kaunas) 41:741–746Google Scholar
  16. 16.
    Bozzetti F (2005) Pelvic drainage and other risk factors for leakage after anterior resection in rectal cancer patients. Ann Surg 242:902; author reply 902–903PubMedCrossRefGoogle Scholar
  17. 17.
    Bozzetti F (2006) Drainage and other risk factors for leakage after anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 243:140–141; author reply 141PubMedCrossRefGoogle Scholar
  18. 18.
    Lipska MA, Bissett IP, Parry BR et al (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76:579–585PubMedCrossRefGoogle Scholar
  19. 19.
    Makela JT, Kiviniemi H, Laitinen S (2003) Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 46:653–660PubMedCrossRefGoogle Scholar
  20. 20.
    Nash GF (2004) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence colectomy (Br J Surg 2003; 90:1261–1266). Br J Surg 91:125–126PubMedCrossRefGoogle Scholar
  21. 21.
    Rullier E, Laurent C, Garrelon JL et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358PubMedCrossRefGoogle Scholar
  22. 22.
    Teoh CM, Gunasegaram T, Chan KY et al (2005) Review of risk factors associated with the anastomosis leakage in anterior resection in Hospital Universiti Kebangsaan Malaysia. Med J Malaysia 60:275–280PubMedGoogle Scholar
  23. 23.
    Vignali A, Gianotti L, Braga M et al (2000) Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82PubMedCrossRefGoogle Scholar
  24. 24.
    Walker KG, Bell SW, Rickard MJ et al (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240:255–259PubMedCrossRefGoogle Scholar
  25. 25.
    Yeh CY, Changchien CR, Wang JY et al (2005) Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 241:9–13PubMedGoogle Scholar
  26. 26.
    Bruce J, Krukowski ZH, Al-Khairy G et al (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88:1157–1168PubMedCrossRefGoogle Scholar
  27. 27.
    Petersen S, Freitag M, Hellmich G et al (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 13:160–163PubMedCrossRefGoogle Scholar
  28. 28.
    Branagan G, Finnis D (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48:1021–1026PubMedCrossRefGoogle Scholar
  29. 29.
    Averbach AM, Chang D, Koslowe P et al (1996) Anastomotic leak after double-stapled low colorectal resection. Dis Colon Rectum 39:780–787PubMedCrossRefGoogle Scholar
  30. 30.
    Bokey EL, Chapuis PH, Fung C et al (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38:480–486; discussion 486–487PubMedCrossRefGoogle Scholar
  31. 31.
    Hansen O, Schwenk W, Hucke HP et al (1996) Colorectal stapled anastomoses. Experiences and results. Dis Colon Rectum 39:30–36PubMedCrossRefGoogle Scholar
  32. 32.
    Poon RT, Chu KW, Ho JW et al (1999) Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 23:463–467; discussion 467–468PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Won-Suk Lee
    • 1
  • Seong Hyeon Yun
    • 1
  • Young-Nam Roh
    • 1
  • Hae-Ran Yun
    • 1
  • Woo Yong Lee
    • 1
  • Yong Beom Cho
    • 1
  • Ho-Kyung Chun
    • 1
    Email author
  1. 1.Department of SurgerySamsung Medical Center, Sungkyunkwan University School of MedicineGangnam-guKorea

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