To explore the related factors about the occurrence of anastomotic leakage by Colorectal Leakage Scoring System (CLS) in laparoscopic anterior resection and share the experience on the prevention and treatment of anastomotic leakage in our department.

Clinical data of 582 rectal cancer patients who underwent elective laparoscopic anterior resection from January 2014 to June 2017 at Affiliated Sichuan Tumor Hospital of Electronic Science and Technology University were retrieved. Demographic data were collected in CLS to evaluate the risk of anastomotic leakage.

Of all the 582 enrolled patients, the cases of anastomotic leakage and symptomatic anastomotic leakage were 43 (7.3%) and 29 (4.9%) respectively. In univariate analysis, gender, American Society of Anesthesiologists (ASA), intoxication, neoadjuvant therapy, distance between anastomosis and anal verge, additional procedures, blood loss (mL) and blood transfusion, duration of operation were significantly associated with postoperative anastomotic leak (P<0.05) . Multivariate analysis showed that ASA (OR 3.173, 95%CI: 1.848~5.448) , intoxication (OR 3.898, 95%CI: 2.144~7.085), distance between anastomosis and anal verge (OR 1.718, 95%CI: 1.3605~2.262) , additional procedures (OR 11.353, 95%CI: 3.387~38.058) , duration of operation (OR 1.622, 95%CI: 1.144~2.301) , protective enterostomy (OR 0.024, 95%CI: 0.005~0.123) and the application of modified pelvic reconstruction or not (OR 0.271, 95%CI: 0.091~0.803) were the independent risk factors of anastomotic leak following laparoscopic anterior resection for the rectal cancer. The CLS has a good value of predicting anastomotic leakage after laparoscopic anterior resection of rectal cancer. CLS scored 12 could be considered as a high critical risk predictive value of anastomotic leakage after laparoscopic anterior resection.

For patients with the CLS score of more than 12 after laparoscopic anterior resection, the occurrence of postoperative anastomotic leakage should be monitored. Modified laparoscopic technique can effectively prevent the occurrence of AL.