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Updated: May 31, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection
C H Richards1, V Campbell, C Ho
1Department of Surgical Science, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. colinrichards@nhs.net
Aim:
To examine modifiable risk factors for anastomotic leak in patients undergoing low anterior resection.
Method:
In total 233 patients undergoing low anterior resection for benign and malignant disease over a 10-year period at a single surgical unit were identified from a prospective database. The relationships between anastomotic leak and 17 variables were examined, including patient demographics, operative technique, tumour pathology, preoperative physiological function and smoking status.
Results:
The majority (91%) of operations were carried out for rectal cancers, and 24 procedures (10%) were performed with laparoscopic assistance. The overall anastomotic leak rate was 14% (33/233). Patients with anastomotic leak had higher 30-day mortality (6%vs 1%, P<0.05) and stayed significantly longer in hospital (median 23 vs 10 days, P<0.001). On multivariate analysis, current smokers (OR 3.68, 95% CI 1.38-9.82, P=0.009) and patients with evidence of metastatic malignant disease (OR 3.43, 95% CI 1.29-9.13, P=.013) were at increased risk of anastomotic leak.
Conclusion:
Smoking and the presence of metastatic disease are major risk factors for the development of anastomotic leak following low anterior resection.
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