A'high tie'confers an increased risk of anastomotic leakage for lower rectal cancer surgery in patients treated with preoperative radiotherapy.

PURPOSE: This study aimed at analyzing retrospectively the risk factors for anastomotic leakage for lower rectal cancer treated with preoperative radiotherapy.
METHODS: The subjects were 108 patients with T3 lower rectal cancer, who underwent curative resection following preoperative radiotherapy. All patients had a diverting stoma made. Univariate and multivariate analyses were conducted for the independent clinical variables.
RESULTS: Anastomotic leakage developed in 19 (17.6 %) patients. Univariate analysis of the risk factors for anastomotic leakage revealed that arterial ligation with a high tie (p = 0.001), undifferentiated tumor type (p = 0.002), a shorter distance from the anal verge (p = 0.086), and a longer hospital stay (p = 0.0002) were significant predictors of leakage. Multivariate analysis revealed that a high tie [hazard ratio 12.22 (95 % confidence interval 2.83-87.94); p = 0.0003], undifferentiated tumor type [91.15 (5.98-3128.03); p = 0.0008], and a long hospital stay [13.03 (2.86-104.93); p = 0.0004] were independently associated with anastomotic leakage.
CONCLUSION: Our data suggest that preoperative radiotherapy and a high tie for lower rectal cancer are independent risk factors for anastomotic leakage.