Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors

The study was designed to identify the risk factors associated with anastomotic leakage after an intraperitoneal large-bowel anastomosis in patients with colorectal malignancy.

The prospectively collected data of patients who underwent colorectal resection for malignancy with primary anastomosis above the pelvic peritoneal reflection for malignancy between 1996 and 2004 were reviewed. Thirty-five variables were evaluated using univariate and multivariate analysis.

A total of 1,417 patients were studied and anastomotic leakage occurred in 25 patients (1.8 percent). Twenty-two patients (88 percent) required reoperation for anastomotic leakage. The hospital stay (28 vs. 10 days, P < 0.001) and mortality rate (32 vs. 4 percent, P < 0.001) of patients with anastomotic leakage were significantly increased compared with those without leakage. Multivariate analysis showed that American Society of Anesthesiologists Grade 3 to 5 (P = 0.04; odds ratio, 5.6; 95 percent confidence interval, 1.6-15.3) and emergency operation (P = 0.03; odds ratio, 4.6; 95 percent confidence interval, 1.9-9.8) were independent factors associated with anastomotic leakage. The risk of anastomotic leakage was 8.1 percent (odds ratio, 10.5; 95 percent confidence interval, 2.7-26.8) if both factors were present.

Intraperitoneal anastomosis after large-bowel resection is associated with a low leakage rate. Emergency surgery and a high American Society of Anesthesiologists grade are independent factors associated with an increased incidence of leakage. A temporary diverting stoma to protect the primary anastomosis or even avoidance of anastomosis could be considered for patients with the two risk factors present.