Incidence and risk factors for anastomotic leakage after transanal total mesorectal excision in a retrospective cohort of 212 patients

Anastomotic leakage remains a major complication in colorectal surgery. Although several risk factors have been identified, the specific risks associated with TaTME procedures require further clarification. The aim of this study was to determine the frequency of anastomotic leakage after TaTME and to identify factors influencing leakage rates. Out of 237 patients who underwent TaTME, 229 received an anastomosis. Seventeen were excluded from further analysis-14 due to lack of leakage assessment before ileostomy closure and 3 due to missing follow-up data-resulting in a final cohort of 212 patients. Cases were analysed with respect to anastomotic technique and other variables potentially affecting the incidence of anastomotic leakage. Data were obtained from a prospectively maintained institutional database. The mean tumour distance from the anorectal junction (ARJ) was 2.92 cm (± 1.56). Anastomotic leakage occurred in 27 patients (12.74%). The only statistically significant risk factor for leakage was the type of anastomosis: leakage occurred in 18.28% of patients with hand-sewn anastomosis and in 8.47% of those with stapled anastomosis. Tumour height indirectly influenced the leakage rate, as hand-sewn anastomosis was used predominantly in lower tumours (1.78 cm vs. 3.82 cm from the ARJ). Anastomotic leakage rates after TaTME are comparable to those reported for other rectal cancer surgical techniques. Leakage risk is primarily determined by the type of anastomosis and, indirectly, by tumour height. TaTME appears to be a feasible option for selected patients in experienced centres, although further validation is required.