Research Article
Byrne C , Smith RA, Abdelrazeq
Abstract
Background: Anastomotic leakage is an important source of morbidity and mortality in patients undergoing neoadjuvant therapy and low anterior resection for rectal cancer despite use of concurrent defunctioning stoma. The objective of this study was to identify any preoperative haematological factors which may be associated with an increased risk of anastomotic leak in this patient group. Methods: Retrospective data collection was undertaken for patients undergoing surgery between 2007 and 2012. Results: 48 patients were identified of whom 13 (27%) developed an anastomotic leak. The median time interval from surgery to diagnosis of leak was 8 (IQR=2 to 14) weeks - only 5 leaks (10%) presented during the initial postoperative stay. A low preoperative platelet (logistic regression, p=0.027) and white cell count (p=0.049) were found to have a significant association with an increased risk of leak. It was possible to construct a simple additive risk score (white cell ≤ 4.5 x109/l=1/platelet count ≤ 250 x109/l=1) allowing a significant degree of risk stratification for anastomotic leak (score 0=1/19 (5% leak rate), score 1=5/18 (28%), score 2=7/11 (64%)). Conclusion: Low platelet and white cell counts at the time of surgery may be associated with an increased risk of anastomotic leak in patients undergoing low anterior resection following preceding neoadjuvant therapy.