Risk factors of anastomotic leakage and long-term survival after colorectal surgery

Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes. We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data. Male sex (odds ratio [OR], 3.90; P<0.001), intraoperative transfusion (OR, 2.31; P<0.042), and operative time (OR, 1.73; P<0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; P<0.001), neoadjuvant chemoradiotherapy (OR, 2.26; P<0.001), and regional lymph node metastasis (OR, 1.43; P<0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; P<0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; P<0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, P<0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, P<0.005, respectively). AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery.