Risk Factors for Anastomotic Leakage After Elective Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Single-Center Retrospective Study of 532 Patients

Haibo Luo, Yinuo Wang*

Received : May 07, 2026 | Published : June 23, 2026

Citation: Luo H, Wang Y. Risk Factors for Anastomotic Leakage After Elective Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Single Center Retrospective Study of 532 Patients. J Case Rep Rev Med. 2026;2(2):1‑6.

Abstract

Background: Anastomotic leakage (AL) is a severe complication after laparoscopic total mesorectal excision (TME) for rectal cancer, yet risk factors specific to this homogeneous surgical setting remain incompletely defined. This study aimed to investigate the incidence and independent risk factors for AL in patients undergoing elective laparoscopic TME for rectal cancer.

Methods: This single‑center retrospective cohort study included 532 consecutive patients who underwent elective laparoscopic TME with primary anastomosis for rectal cancer between January 2024 and January 2026. Demographic, clinical, tumor‑related, and surgical variables were collected from electronic medical records. Univariate and multivariable logistic regression analyses were performed to identify independent risk factors for AL.

Results: The overall incidence of AL was 12.2% (65/532). Multivariable analysis identified three independent risk factors: diabetes mellitus (OR = 3.20, 95% CI: 1.84–5.58, P < 0.001), smoking history (OR = 2.13, 95% CI: 1.21–3.73, P = 0.008), and advanced tumor stage (III–IV vs. I–II, OR = 1.92, 95% CI: 1.13–3.24, P = 0.015). Age and neoadjuvant chemoradiotherapy were not independently associated with AL in the multivariable model.

Conclusions: Diabetes, smoking history, and advanced tumor stage are independent risk factors for anastomotic leakage after elective laparoscopic TME for rectal cancer. These easily accessible preoperative variables can aid in risk stratification and guide targeted preventive strategies, such as optimizing glycemic control, promoting smoking cessation, and considering diverting stoma in high‑risk patients. Prospective multicenter studies are warranted to validate these findings and develop a practical risk prediction tool.