Risk factors for colorectal anastomotic leakage and preventive measures: a retrospective cohort study

Background. Colorectal anastomotic leakage (AL) has always been one of major challenges in rectal surgery.

Objective: to perform multivariate analysis of risk factors for AL.

Materials and methods. In this retrospective cohort study, we analyzed patients that had undergone resection of the rectum with anastomosis formation between 2013 and 2020. We included patients with favorable prognostic factors (tumor located >5 cm above the anal verge, no history of chemoradiotherapy). We performed multivariate analysis using logistic regression to assess risk factors for AL.

Results. The use of more than 3 linear stapler firings to suture the rectum significantly increased the risk of AL (risk ratio 3.035; 95 % confidence interval 1.473–6.252; p = 0.003). The univariate analysis demonstrated that reinforcement of the anastomosis was significantly associated with an increased risk of AL (risk ratio 2.35; 95 % confidence interval 1.112–5.762; p = 0.027); however, this association failed to reach statistical significance (risk ratio 1,520; p = 0,066). Pelvic peritoneum suturing had no impact on the AL incidence, but in case of its development, pelvic peritoneum reconstruction prevented peritonitis (p = 0.002).

Conclusion. The number of stapler firings >3 used to suture the rectum, as well as reinforcement of the anastomosis tended to increase the risk of AL; however, these findings did not reach the level of statistical significance. Pelvic peritoneum reconstruction did not affect the incidence of AL, but significantly reduced the risk of peritonitis.