COMPREHENSIVE ASSESSMENT OF RISK FACTORS FOR COLORECTAL ANASTOMOTIC LEAKAGE IN RECTAL CANCER SURGERY

Authors

DOI:

https://doi.org/10.11603/2414-4533.2025.3.15665

Keywords:

Rectal cancer, colorectal anastomosis, anastomotic leakage, risk factors, laparoscopic resection, postoperative complications

Abstract

The aim of the work: to improve treatment outcomes in patients with rectal cancer by analyzing key risk factors for anastomotic leakage (AL) at the preoperative, intraoperative, and postoperative stages.

Materials and Methods. This retrospective single-center study included 92 patients with stage I–III rectal adenocarcinoma (TNM: cT1–4, N0–2, M0), located within 15 cm from the anal verge and without involvement of the anal sphincter. All patients underwent laparoscopic anterior or low anterior resection with colorectal anastomosis. Based on the presence of clinically significant leakage, patients were divided into two groups: AL (+) – 17 patients (18.5 %) and AL (-) – 75 patients (81.5 %). A range of clinical, morphological, and surgical variables were analyzed and categorized according to treatment stages.

Results. The rate of clinically significant AL was 18.5 %. Statistically significant risk factors included: distal tumor location (5–10 cm from the anal verge) (p=0.001), prolonged operative time (p=0.024), D3 lymph node dissection (p=0.009), use of ≥2 linear stapler firings (p=0.020), absence of splenic flexure mobilization (p=0.012), and ligation of the left colic artery (p=0.001). Elevated C-reactive protein level on postoperative day 3, fever, and tachycardia may serve as early clinical-laboratory markers of AL and indicate the need for prompt diagnostic and therapeutic interventions.

Conclusions. Identifying key risk factors for colorectal anastomotic leakage – particularly those related to tumor location, surgical technique, and early signs of inflammation – enables timely detection of high-risk patients and prevention of postoperative complications.

Author Biographies

V. V. VASYLIV, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine

Graduate Student (PhD Candidate) of the Department of Surgery of Postgraduate Education and Urology

V. D. SKRYPKO, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine

DSc (Medicine), Professor of the Department of Surgery of Postgraduate Education and Urology

References

He J, He M, Tang JH. Anastomotic leak risk factors following colon cancer resection: a systematic review and meta-analysis. Langenbecks Arch Surg. 2023; 408:252. DOI: 10.1007/s00423-023-02989-z. DOI: https://doi.org/10.1007/s00423-023-02989-z

Marino M, Verberne C, Merchant JF, Hassan SA, Witjes CD, Lindsey I. Balancing Risk in Rectal Cancer Surgery: A Retrospective Cohort Study Examining the Consequences of Anastomotic Leaks and Diversion. Turk J Colorectal Dis. 2025; 5(2):48-54. DOI: 10.4274/tjcd.galenos.2025.2025-2-8. DOI: https://doi.org/10.4274/tjcd.galenos.2025.2025-2-8

Litchinko A, Buchs N, Balaphas A, Toso C, Liot E, Meurette G, Ris F, Meyer J. Score prediction of anastomotic leak in colorectal surgery: a systematic review. Surg Endosc. 2024; 38(4):1723-30. DOI: 10.1007/s00464-024-10705-1. DOI: https://doi.org/10.1007/s00464-024-10705-1

Celotto F, Bao QR, Capelli G, Spolverato G, Gumbs AA. Machine learning and deep learning to improve prevention of anastomotic leak after rectal cancer surgery. World J Gastrointest Surg. 2025; 17(1):101772. DOI: 10.4240/wjgs.v17.i1.101772. DOI: https://doi.org/10.4240/wjgs.v17.i1.101772

Li R, Zhou J, Zhao S, Qiannan S, Daorong W. Prediction model of anastomotic leakage after anterior resection for rectal cancer–based on nomogram and multivariate analysis with 1995 patients. Int J Colorectal Dis. 2023; 38:139. DOI: 10.1007/s00384-023-04438-1. DOI: https://doi.org/10.1007/s00384-023-04438-1

Zhao Y, Li B, Sun Y, Liu Q, Cao Q, Li T, Li J. Risk Factors and Preventive Measures for Anastomotic Leak in Colorectal Cancer. Technol Cancer Res Treat. 2022; 21:15330338221118983. DOI: 10.1177/15330338221118983. DOI: https://doi.org/10.1177/15330338221118983

Tonini V, Zanni M. Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery. World J Gastrointest Surg. 2023; 15:745-56. DOI: 10.4240/wjgs.v15.i5.745. DOI: https://doi.org/10.4240/wjgs.v15.i5.745

Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Büchler MW. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010 Mar; 147(3):339-51. DOI: 10.1016/j.surg.2009.10.012. DOI: https://doi.org/10.1016/j.surg.2009.10.012

Zarnescu EC, Zarnescu NO, Costea R. Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics (Basel). 2021; 11(12):2382. DOI: 10.3390/diagnostics11122382. DOI: https://doi.org/10.3390/diagnostics11122382

Ito T, Obama K, Sato T, Matsuo K, Inoue H, Kubota K, et al. Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg. 2017; 10:17-22. DOI: 10.1111/ases.12310. DOI: https://doi.org/10.1111/ases.12310

Awad S, El-Rahman, AIA, Abbas, A et al. The assessment of perioperative risk factors of anastomotic leakage after intestinal surgeries; a prospective study. BMC Surg. 2021; 21:29. DOI: 10.1186/s12893-020-01044-8. DOI: https://doi.org/10.1186/s12893-020-01044-8

Yu Xn, Xu Lm, Bin Yw et al. Risk Factors of Anastomotic Leakage After Anterior Resection for Rectal Cancer Patients. CURR MED SCI. 2022; 42:1256-66. DOI: 10.1007/s11596-022-2616-2. DOI: https://doi.org/10.1007/s11596-022-2616-2

Brisinda G, Chiarello MM, Pepe G, Cariati M, Fico V, Mirco P, Bianchi V. Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors. World J Clin Cases. 2022; 10(36):13321-36. DOI: 10.12998/wjcc.v10.i36.13321. DOI: https://doi.org/10.12998/wjcc.v10.i36.13321

Ge W, Shao Lh, Chen G. Suspension and suturing technique can reduce the incidence of anastomotic leakage after rectal cancer excision: a single, prospective, cohort study. Sci Rep. 2024; 14:29197. DOI: 10.1038/s41598-024-79800-6. DOI: https://doi.org/10.1038/s41598-024-79800-6

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Published

2025-10-23

How to Cite

VASYLIV, V. V., & SKRYPKO, V. D. (2025). COMPREHENSIVE ASSESSMENT OF RISK FACTORS FOR COLORECTAL ANASTOMOTIC LEAKAGE IN RECTAL CANCER SURGERY . Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (3), 114–120. https://doi.org/10.11603/2414-4533.2025.3.15665

Issue

No. 3 (2025)

Section

EXPERIENCE OF WORK

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Copyright (c) 2025 В. В. ВАСИЛІВ, В. Д. СКРИПКО

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