Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management

Sergio Alfieri, Fausto Rosa, Valerio Papa, Antonio Pio Tortorelli, Alejandro Martin Sanchez, Dario Di Miceli, Giovanni Doglietto

Research output: Contribution to journalArticle

14 Citations (Scopus)


We investigated risk factors and prognostic implications of symptomatic anastomotic leakage after anterior resection for rectal cancer, and the influence of a diverting stoma. Our retrospective review of prospective collected data analyzed 475 patients who underwent anterior resection for rectal cancer. Uni- and multivariate analysis was made between anastomotic leakage and patient, tumor, and treatment variables, either for the overall group (n = 475) and in the midlow rectal cancer subgroup (n = 291). Overall rate of symptomatic leakage was 9 per cent (43 of 475) with no related postoperative mortality. At univariate analysis, significant factors for leak were a tumor less than 6 cm from the anal verge (13.7 vs 6.6%; P = 0.011) and intraoperative transfusions (16.9 vs 4.3%; P = 0.001). Similar results were observed in the midlow rectal cancer subgroup. At multivariate analysis, no parameter resulted in being an independent prognostic factor for risk of leakage. In patients with a leakage, a temporary enterostomy considerably reduced the need for reoperation (12.5 vs 77.8%; P < 0.0001) and the risk of a permanent stoma (18.7 vs 28.5%; P = 0.49). The incidence of anastomotic failure increases for lower tumors, whereas it is not influenced by radiotherapy. Defunctioning enterostomy does not influence the leak rate, but it mitigates clinical consequences.
Original languageEnglish
Pages (from-to)41-47
Number of pages7
Publication statusPublished - 2015


  • Adenocarcinoma
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical
  • Anastomotic Leak
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prognosis
  • Rectal Neoplasms
  • Risk Factors


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