Predictors of anastomotic leak after anterior rectal resections for localized malignant neoplasms

BACKGROUND: Anastomotic leak is the most serious complication in rectal surgery. Predicting and preventing anastomotic leak remains an urgent task.

AIM: The purpose of the study is to analyze the 17-year-long experience of the Federal Research Clinical Center of Specialized Medical Care and Medical Technologies of FMBA of Russia in performing an anterior resection of the rectum in patients with cancer of the rectum and rectosigmoid junction and to establish the risk factors for the development of an anastomotic leak.

METHODS: The results of the treatment of 492 patients who underwent an anterior resection of the rectum in 2006–2022 have been studied. 21 patients developed an anastomotic leak. A retrospective comparison of the characteristics of two groups of patients was carried out: those with a smooth course of the postoperative period and those with the development of an anastomotic leak.

RESULTS: The reliable risk factors for the development of an anastomotic leak were identified and, based on the statistical analysis, a prognostic scoring model was proposed: smoking — 1 point, type 2 diabetes mellitus — 1 point, preoperative chemotherapy — 1 point, blood loss over 50 ml — 2 points, preoperative radiation therapy — 3 points, and the location of the colorectal anastomosis at a distance of up to 5 cm from the anus — 4 points. The sensitivity of the model was 85.6%, with the specificity above 97.4% when using a training set with 8 points or more.

CONCLUSION: The following tactics are proposed: in the case of 4 points and above by the developed scale, one should form a preventive intestinal stoma; in the case of 1–3 points, one should install a transanal drainage. The complete abandonment of these two preventive measures is possible only if the patient does not have any of the listed risk factors for the development of an anastomotic leak.