[Multivariate analysis of risk factors associated with dehiscence of colorectal anastomosis after anterior or lower anterior resection for sigmoid or rectal cancer].

INTRODUCTION: Clinical anastomotic leakage remains a major problem after anterior or low anterior resection for rectal or sigmoid cancer.

OBJECTIVE: To analyze risk factors associated with this complication.

MATERIAL AND METHODS: From January 1992 to December 2000, 232 anterior or low anterior resections were performed. An univariate and multivariate analysis were performed as to find the risk factors.

RESULTS: There were 122 females and 110 males, mean age was 58.5 +/- 14.1. Tumors were located as follows: low third (n = 10), middle third (n = 104), upper third (n = 52) and sigmoid (n = 66). Ninety-two patients received preoperative radiotherapy +/- chemotherapy. Twenty-six (11.6%) had diabetes mellitus, 52 (22.4%) hypertension and 31 (13.4%) mixed cardiopathy. Forty-six patients (19.8%) had > 90% of tumor obstruction. Mean levels of serum albumin and lymphocytes were 3.7 +/- .62 g/L y de 2,026 +/- 1,576/mm3, respectively. Tumors mean distance from the anal verge was 10.2 +/- 6.7 cm. Colorectal anastomoses were performed with the following techniques: double stapled (n = 92), single stapled (n = 85) and manual (n = 55). Multivisceral resection was performed in 29 patients (12.5%); a diverting colostomy was performed in 54 patients (23.2%). Mean intraoperative haemorrhage was 505.3 +/- 393.5 mL. Mean operative time was 267.4 +/- 83 min. Sixty patients (27.2%) received blood transfusion. Mean tumor size was 4.8 +/- 2.6 cm. Tumor stage was as follows: T0-, T2, N0 (n = 60), T3, T4, N0 (n = 103), any T, N+ (n = 55) y T3-4, N+, M+ (n = 14). Nineteen patients (8.1%) developed clinical anastomotic leakage. No operative mortality was observed. Adverse risk factors for clinical anastomotic leakage were: gender (male), preoperative albumin levels < 3 g/L, preoperative tumor obstruction (> 90%) and distance of the anastomosis from the anal verge (< 7 cm).

CONCLUSIONS: In patients with these adverse risk factors a diverting colostomy or ileostomy should be performed, as to avoid fecal peritonitis.