Predictive Factors for Anastomotic Leakage Following Low Anterior Resection in Rectal Cancer: A Retrospective Cohort...

Anastomotic leakage (AL) is a major complications following Low Anterior Resection (LAR) for rectal cancer. Identifying risk factors is critical to improving surgical outcomes. This retrospective study analyzed 230 patients with rectal cancer who underwent LAR following neoadjuvant chemoradiotherapy (NCRT) between 2016 and 2024. Patient demographics, tumor characteristics, surgical factors, and postoperative outcomes were examined. Chi-square and t-tests identified significant variables, which were further analyzed using logistic regression. ROC curve analysis determined cutoff values, sensitivity, and specificity for significant predictors. Anastomotic leakage was observed in 18 patients (7.8%). BMI was significantly higher in the AL group (27.89 ± 3.69) compared to the non-AL group (25.67 ± 3.54, p = 0.012). Operative duration was also longer in patients with AL (243.69 ± 86.89 min vs. 192.37 ± 72.4 min, p = 0.005). Logistic regression identified BMI (OR: 1.164, 95% CI: 1.018-1.330, p = 0.027) and operative duration (OR: 1.006, 95% CI: 1.001-1.012, p = 0.018) as independent predictors of AL. ROC analysis showed a BMI cutoff of 27.77 (sensitivity 61.1%, specificity 75.9%) and an operative time cutoff of 175 min (sensitivity 88.9%, specificity 43.4%). Higher BMI and prolonged operative duration independently predict AL after LAR. Addressing these factors preoperatively may help reduce complications and improve patient outcomes.