BACKGROUND:Anastomotic leak remains one of the most severe complications in digestive oncologic surgery, significantly impacting postoperative morbidity and mortality. METHODS:A retrospective observational study was conducted. We collected and analyzed the data for 394 patients with digestive cancer, of which 248 received resection with primary anastomosis. The following variables were analyzed: tumor origin distribution, body mass index (BMI), gender, age, smoking status, tumor stage, American Society of Anesthesiologists score (ASA), hemoglobin levels and surgical indication (elective or emergency). RESULTS:Anastomotic leakage occurred in 38,4% of cases. Univariate analysis showed significant associations with ASA >= 3, advanced tumor stage, emergency surgery, smoking, underweight BMI, and anemia severity (risk increased in a severity-dependent manner). Multivariate analysis identified ASA >= 3 (OR 9.60; p<0.001), mild anemia (OR 3.11; p=0.005), moderate/severe anemia (OR 7.63; p<0.001), and advanced tumor stage (OR 2.43; p=0.018) as independent predictors. CONCLUSIONS:Preoperative physiological status and anemia severity are independently associated with anastomotic leak following digestive cancer surgery. The graded effect of anemia suggests a potentially modifiable risk factor amenable to preoperative optimization. Advanced malignancy (stages III and IV) plays an independent role in anastomotic leakage incidence.
