Preoperative Predictors of Anastomotic Leak Following Digestive Cancer Surgery: A Retrospective Cohort Study

Anastomotic leak remains one of the most severe complications in digestive oncologic surgery, significantly impacting postoperative morbidity and mortality.

A retrospective observational study was conducted. We collected and analyzed the data for 394 patients with digestive cancer, of which 248 received resection with primary anastomosis. The following variables were analyzed: tumor origin distribution, body mass index (BMI), gender, age, smoking status, tumor stage, American Society of Anesthesiologists score (ASA), hemoglobin levels and surgical indication (elective or emergency).

Anastomotic leakage occurred in 38,4% of cases. Univariate analysis showed significant associations with ASA >= 3, advanced tumor stage, emergency surgery, smoking, underweight BMI, and anemia severity (risk increased in a severity-dependent manner). Multivariate analysis identified ASA >= 3 (OR 9.60; p<0.001), mild anemia (OR 3.11; p=0.005), moderate/severe anemia (OR 7.63; p<0.001), and advanced tumor stage (OR 2.43; p=0.018) as independent predictors.

Preoperative physiological status and anemia severity are independently associated with anastomotic leak following digestive cancer surgery. The graded effect of anemia suggests a potentially modifiable risk factor amenable to preoperative optimization. Advanced malignancy (stages III and IV) plays an independent role in anastomotic leakage incidence.