ArticleColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2022
Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group.
Article in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 108 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Comparing the Safety and Efficacy of Virtual Ileostomy Versus Diverting Ileostomy in Patients Underwent Total Mesorectal Excision for Rectal Cancer: a Propensity-matched Study
Virtual Ileostomy Versus Conventional Loop Ileostomy in Patients Undergoing Low Anterior Resection for Rectal Cancer: A Randomized Controlled Study
Comparing the Safety and Efficacy of Virtual Ileostomy Versus Diverting Ileostomy in Patients Undergoing Total Mesorectal Excision for Rectal Cancer: a Multicentre, Prospective, Open-label, Blinded Endpoint, PROBE Study
Who cites it
108 citing papers in PubMed, 6 syntheses or guidelines pooled it, 142 citations in OpenAlex.
- Pooled it
- Single-stapled versus non-single-stapled colorectal anastomosis in minimally invasive anterior resections: a systematic review and meta-analysis.Techniques in coloproctology · 2026Pooled it
- The impact of the number of stapler firings on anastomotic leakage in minimally invasive rectal surgery: risk factor or technical marker of complexity? A systematic review, meta‑analysis, and metaregression.Techniques in coloproctology · 2026Pooled it
- Low Versus High Ligation of Inferior Mesenteric Artery in Rectal and Sigmoid Cancers: A Systematic Review, Meta-analysis, and Trial Sequential Analysis of Randomized Controlled Trials.Annals of surgical oncology · 2026Pooled it
- Abdominoperineal pull-through with delayed coloanal anastomosis for pelvic anastomotic failure-a systematic review.Techniques in coloproctology · 2025Pooled it
- Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis.International journal of colorectal disease · 2024Pooled it
- Trial
- Machine learning model-guided selective use of temporary diverting ileostomy in rectal cancer surgery: a randomized controlled trial.Nature communications · 2026Trial
- The ILEOSTIM trial: A multicentre randomised controlled trial evaluating the impact of efferent loop stimulation prior to ileostomy reversal on postoperative ileus.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026Trial
- Comparison of two bundles for reducing surgical site infection in colorectal surgery: multicentre cohort study.BJS open · 2024Trial
- Clinical application of the B-type sutured ileostomy in robotic-assisted low anterior resection for rectal cancer: a propensity score matching analysis.Journal of robotic surgery · 2024Trial
- Magnetic resonance imaging-based deep learning model to predict multiple firings in double-stapled colorectal anastomosis.World journal of gastroenterology · 2023Trial
- Association between left colic artery preservation and surgical outcomes after laparoscopic radical resection for rectal cancer: a propensity score-matched analysis.Updates in surgery · 2026Article
- The application value of Da Vinci linear powered stapler SureForm in robotic sphincter-preserving surgery for rectal cancer: a prospective randomized clinical trial.Surgical endoscopy · 2026Article
- The Treatment Efficacy for Patients Undergoing Combined Transanal-Transabdominal Endoscopic Resection of Rectal Anastomosis Stenosis.Journal of surgical oncology · 2026Article
- Article
- Comparing the safety and efficacy of virtual ileostomy versus diverting ileostomy in patients undergoing total mesorectal excision for rectal cancer: a propensity-matched study.Surgical endoscopy · 2026Article
- Enhanced recovery protocols: compliance and outcome in elective vs. emergency colorectal surgery.Langenbeck's archives of surgery · 2026Article
- Prognostic value of hematological markers for anastomotic leakage diagnosed after postoperative day 5 following laparoscopic surgery for colorectal cancer.BMC surgery · 2026Article
- Utilization of indocyanine green fluorescence angiography in redo IPAA surgery.International journal of colorectal disease · 2026Article
48 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
25 authors at 12 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimAnastomotic leakage after restorative surgery for rectal cancer shows high morbidity and related mortality. Identification of risk factors could change operative planning, with indications for stoma construction. This retrospective multicentre study aims to assess the anastomotic leak rate, identify the independent risk factors and develop a clinical prediction model to calculate the probability of leakage.
methodsThe study used data from 24 Italian referral centres of the Colorectal Cancer Network of the Italian Society of Surgical Oncology. Patients were classified into two groups, AL (anastomotic leak) or NoAL (no anastomotic leak). The effect of patient-, disease-, treatment- and postoperative outcome-related factors on anastomotic leak after univariable and multivariable analysis was measured.
resultsA total of 5398 patients were included, 552 in group AL and 4846 in group NoAL. The overall incidence of leaks was 10.2%, with a mean time interval of 6.8 days. The 30-day leak-related mortality was 2.6%. Sex, body mass index, tumour location, type of approach, number of cartridges employed, weight loss, clinical T stage and combined multiorgan resection were identified as independent risk factors. The stoma did not reduce the leak rate but significantly decreased leak severity and reoperation rate. A nomogram with a risk score (RALAR score) was developed to predict anastomotic leak risk at the end of resection.
conclusionsWhile a defunctioning stoma did not affect the leak risk, it significantly reduced its severity. Surgeons should recognize independent risk factors for leaks at the end of rectal resection and could calculate a risk score to select high-risk patients eligible for protective stoma construction.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.