• C H Richards, V Campbell, C Ho, J Hayes, T Elliott, and M Thompson-Fawcett.
• Department of Surgical Science, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. colinrichards@nhs.net
• Colorectal Dis. 2012 May 1;14(5):628-33.

AimTo examine modifiable risk factors for anastomotic leak in patients undergoing low anterior resection.MethodIn total 233 patients undergoing low anterior resection for benign and malignant disease over a 10-year period at a single surgical unit were identified from a prospective database. The relationships between anastomotic leak and 17 variables were examined, including patient demographics, operative technique, tumour pathology, preoperative physiological function and smoking status.ResultsThe majority (91%) of operations were carried out for rectal cancers, and 24 procedures (10%) were performed with laparoscopic assistance. The overall anastomotic leak rate was 14% (33/233). Patients with anastomotic leak had higher 30-day mortality (6%vs 1%, P<0.05) and stayed significantly longer in hospital (median 23 vs 10 days, P<0.001). On multivariate analysis, current smokers (OR 3.68, 95% CI 1.38-9.82, P=0.009) and patients with evidence of metastatic malignant disease (OR 3.43, 95% CI 1.29-9.13, P=.013) were at increased risk of anastomotic leak.ConclusionSmoking and the presence of metastatic disease are major risk factors for the development of anastomotic leak following low anterior resection.© 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

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