Risk Factors for Anastomotic Leakage Following Intersphincteric Resection for Very Low Rectal Adenocarcinoma

The aim of this study was to perform a retrospective analysis of the risk factors for anastomotic leakage following intersphincteric resection (ISR) for very low rectal cancer.

Between 1993 and 2007, 120 patients with T1–T3 rectal adenocarcinomas located 1 to 5 cm (median 3 cm) from the anal verge underwent ISR without radiotherapy. Univariate and multivariate analyses of 47 prospectively recorded parameters were conducted.

All patients had total mesorectal excision after complete bowel preparation. Of them, 103 underwent partial resection, and 17 underwent complete resection of the internal sphincter. Some 108 patients had a defunctioning stoma. Morbidity and mortality rates were 33% and 0.8%, respectively. Fifteen patients (13%) developed clinical leakage, and six (5%) had severe leakage causing relaparotomy, permanent stoma, or death. Univariate analysis of risk factors for clinical leakage revealed tumor annularity, intraoperative blood transfusion, and pulmonary disease to be significant. Multivariate analysis showed transfusion (hazard ratio, 6.5 [95% confidence interval, 1.4 to 30]; p = 0.018) and pulmonary disease (6.3 [1.6 to 26]; p = 0.009) to be independently significant. Moreover, transfusion (71 [3.0 to 1000]; p = 0.008), colonic J-pouch (32 [1.8 to 500]; p = 0.018), and pulmonary disease (32 [1.1 to 1000]; p = 0.044) were independently associated with severe leakage.

This study suggests intraoperative blood transfusion and pulmonary disease as independent risk factors for clinical and severe leakage following ISR and colonic J-pouch as that for severe leakage. By considering these factors, we may be able to stratify high-risk patients and prepare countermeasures.