Impact of perirenal fat distance on the development of rectal anastomotic leaks in patients undergoing laparoscopic low anterior resection

INTRODUCTION: Anastomotic leakage remains a significant complication in rectal cancer surgery. Perirenal Fat Distance (PrFD), an anthropometric measure correlated with visceral fat, has been shown to impact outcomes in various laparoscopic procedures. However, its relationship with anastomotic leakage in laparoscopic rectal cancer surgery has not been well established.
METHODS: This retrospective study included patients who underwent Laparoscopic Low Anterior Resection with Loop Ileostomy for rectal cancer between December 2022 and December 2024. PrFD was measured from preoperative contrast-enhanced CT scans, and anastomotic leakage was classified using the International Study Group of Rectal Cancer (ISREC) criteria. ROC curves were generated to determine the optimal cutoff values for PrFD. Multivariate Cox regression analysis used for determining indipendent prognostic factors for anastomosis leak.
RESULTS: PrFD was found to be significantly associated with anastomotic leakage in laparoscopic rectal cancer surgeries. ROC analysis demonstrated that a PrFD cutoff of 22.35 mm had good sensitivity (72.7%) and specificity (70.0%), with an AUC of 0.815 (p=0.002). Patients with shorter PrFD had a higher incidence of hypoalbuminemia (59.1% vs. 30.0%; p=0.050) and perineural invasion (41.9% vs. 0.0%; p<0.001). Univariate analysis identified PrFD>22.35 mm as a significant risk factor for anastomotic leakage (OR: 6.222; p=0.016).
DISCUSSION AND CONCLUSION: PrFD has been identified as an independent risk factor for anastomotic leakage. Its role in anastomotic leakage development in rectal cancer could be further established through prospective studies with larger cohorts, potentially leading to its widespread clinical use.