Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study

Objective: To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. Background: In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. Methods: Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010–June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. Results: The anastomotic leak rate was 6.6% (46/695; range 1.7%–12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013–1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407–0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228–10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777–39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726–0.971, p = 0.018). Conclusions: Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.