Active Lymphangiogenesis is a Major Risk Factor for Anastomotic Leakage Following Sphincter-Sparing Resection of Rectal Cancer

Objective: Anastomotic leakage is a major complication of rectal surgery and controversy about its risk factors still exists. The aim of present study was to identify risk factors for anastomotic leakage following sphincter-sparing resection of rectal cancer, focusing on the role of tissular lymphatic vessel density (LVD) in tumorous margin and distal clearance margin. Methods: In a 9-year period, from September 1999 to September 2009, 750 consecutive patients who underwent anterior resection with restoration of the bowel continuity were included. Univariate and multivariate analysis were applied to identify risk facrors for anastomotic leakage. Results: The rate of anastomotic leakage was 7.6% (57 of 750 patients). In a multivariate analysis, high LVD in tumorous margin [P = 0.0017; odds ratio (OR) = 5.93; 95% confidence interval (CI) = 2.61-8.514], high LVD in distal clearance margin (P = 0.0011; OR = 6.05; 95% CI = 2.72-10.108) and lower tumor location (P = 0.006; OR = 4.620; 95% CI = 1.76-6.97) were identified as independent factors for anastomotic leakage. A significant LVD correlation was shown by Spearman's rank test between the tumorous and distal clearance margin (r = 0.796). Conclusions: Tissular LVD in tumorous or distal clearance margin and lower tumor location are important risk factors for anastomotic leakage. J. Surg. Oncol. 2011; 104:493-498. (C) 2011 Wiley-Liss, Inc.