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Background <p>Anastomotic stricture (AS) is a&#xa0;significant complication following low anterior resection (LAR) with total mesorectal excision (TME) for rectal cancer and has a&#xa0;relevant impact on patients’ quality of life.</p> Objective <p>This study aimed to identify the independent risk factors associated with benign anastomotic stricture in patients undergoing low anterior resection with total mesorectal excision for rectal cancer using propensity score matching to minimize confounding bias.</p> Methods <p>A&#xa0;retrospective cohort study was conducted at a&#xa0;tertiary care center in Turkey, including 659 patients who underwent LAR with TME for rectal cancer between January 2019 and December 2024. Patients were propensity score matched (1:3) based on age and sex, resulting in 47&#xa0;patients with AS and 141 without. Data on demographics, preoperative laboratory values, clinical characteristics, surgical techniques, and postoperative outcomes were collected. Anastomotic stricture was diagnosed based on digital rectal examination, colonoscopy, or imaging. Univariate and multivariate logistic regression analyses were performed to identify risk factors, with model performance evaluated using receiver operating characteristic (ROC) curves.</p> Results <p>The incidence of AS was 7.3% (47/659). Multivariate analysis identified postoperative anastomotic leakage/fistula (OR: 5.259, 95% CI: 1.929–14.334; <i>p</i> = 0.001), lower rectal tumor location (<i>p</i> = 0.040), and non-mobilized splenic flexure (OR: 0.007, 95% CI: 0.001–0.066; <i>p</i> &lt; 0.001) as independent risk factors for AS. Upper rectal tumors reduced AS risk (OR: 0.063, 95% CI: 0.007–0.619; <i>p</i> = 0.018). The ROC model showed moderate discriminative power for postoperative leakage/fistula (AUC = 0.663; <i>p</i> = 0.001).</p> Conclusion <p>Postoperative anastomotic leakage, lower rectal tumor location, and non-mobilized splenic flexure are significant predictors of AS following LAR. Preventive strategies, including standardized surgical techniques and enhanced perioperative care, are crucial to reduce the incidence of AS.</p>

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Risk factors for anastomotic stricture following low anterior resection for rectal cancer: a retrospective cohort study with propensity score matching

  • 期刊论文

  • 发表日期：

    2026年2月20日

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  • Ahmet Yavuz,
  • Hikmet Pehlivan-Özel,
  • Hüseyin Berkem,
  • Sadettin Er,
  • Mesut Tez

摘要

Background

Anastomotic stricture (AS) is a significant complication following low anterior resection (LAR) with total mesorectal excision (TME) for rectal cancer and has a relevant impact on patients’ quality of life.

Objective

This study aimed to identify the independent risk factors associated with benign anastomotic stricture in patients undergoing low anterior resection with total mesorectal excision for rectal cancer using propensity score matching to minimize confounding bias.

Methods

A retrospective cohort study was conducted at a tertiary care center in Turkey, including 659 patients who underwent LAR with TME for rectal cancer between January 2019 and December 2024. Patients were propensity score matched (1:3) based on age and sex, resulting in 47 patients with AS and 141 without. Data on demographics, preoperative laboratory values, clinical characteristics, surgical techniques, and postoperative outcomes were collected. Anastomotic stricture was diagnosed based on digital rectal examination, colonoscopy, or imaging. Univariate and multivariate logistic regression analyses were performed to identify risk factors, with model performance evaluated using receiver operating characteristic (ROC) curves.

Results

The incidence of AS was 7.3% (47/659). Multivariate analysis identified postoperative anastomotic leakage/fistula (OR: 5.259, 95% CI: 1.929–14.334; p = 0.001), lower rectal tumor location (p = 0.040), and non-mobilized splenic flexure (OR: 0.007, 95% CI: 0.001–0.066; p < 0.001) as independent risk factors for AS. Upper rectal tumors reduced AS risk (OR: 0.063, 95% CI: 0.007–0.619; p = 0.018). The ROC model showed moderate discriminative power for postoperative leakage/fistula (AUC = 0.663; p = 0.001).

Conclusion

Postoperative anastomotic leakage, lower rectal tumor location, and non-mobilized splenic flexure are significant predictors of AS following LAR. Preventive strategies, including standardized surgical techniques and enhanced perioperative care, are crucial to reduce the incidence of AS.