Risk factors for anastomotic leakage in Low Anterior Resection with a Diverting stoma for rectal cancer: A case control study

Background: In rectal cancer surgery, a diverting stoma (DS) is used to reduce anastomotic leakage (AL). However, there is still uncertainty whether use of a DS really avoids AL. In this study, we identified risk factors for AL coexisting with a DS to examine the usefulness of establishment of a DS. Methods The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL. Results Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after operation before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) ≥ 1 ( p  = 0.046) and number of stapler firings ≥ 3 ( p  = 0.002) were associated with AL. In multivariate analysis, only GPS ≥ 1 was significantly associated with increased AL ( p  = 0.033; odds ratio = 4.225; 95% confidence interval 1.122 to 15.905). Conclusion DS creation is effective in avoiding the need for reoperation for AL. Preoperative GPS ≥ 1 is a risk factor for AL in low anterior resection with a DS for rectal cancer.