INCIDENCE OF COLORECTAL ANASTOMOTIC LEAKAGE AND ASSOCIATED FACTORS

Abstract

Objective. The aim of the paper is to to evaluate the incidence of colorectal anastomotic leakage and identify clinical, laboratory, and intraoperative factors associated with it. Materials and Methods. A single-center retrospective study was conducted, involving 306 patients who underwent surgery for rectal tumors with colorectal anastomosis between January 1, 2019, and December 31, 2025. Anastomotic leakage was diagnosed based on a combination of clinical, laboratory, and instrumental data. A comparative assessment of clinical, history-based, intraoperative, and laboratory parameters was performed, followed by univariate and multivariate logistic regression analyses. Results. Colorectal anastomotic leakage was reported in 31 of 306 patients (10.1 %). Its occurrence was associated with a prolonged hospital stay and a more severe postoperative course, characterized predominantly by Clavien–Dindo Grade IIIB complications. Univariate analysis identified the following statistically significant factors: ischemic heart disease, estimated intraoperative blood loss, blood transfusion, multiorgan resection, absence of a protective colostomy, decreased total protein and Prognostic Nutritional Index (PNI) levels and an elevated Neutrophil-to-Lymphocyte Index (NLI) on postoperative day 5. Multivariable analysis identified total protein on postoperative day 5, NLI on postoperative day 5, PNI on postoperative day 5, and ischemic heart disease as independent predictors of anastomotic leakage. Multivariate logistic regression demonstrated strong discriminative power, with the area under the ROC curve of 0.841, a sensitivity of 87.1 % and a specificity of 71.1 %. Conclusion. Colorectal anastomotic leakage is a clinically significant complication associated with a more severe postoperative course and a prolonged hospital stay. In this cohort, the most significant predictors of its development were inflammatory and nutritional status markers on postoperative day 5, and ischemic heart disease. These findings can be used for risk stratification and the optimization of postoperative patient monitoring.