| Summary: | Background: Anastomotic leakage is a common and feared complication of anterior resection of the rectum, leading to a great deal of morbidity and mortality. To this date, the risk/protective factors remain unclear and controversial. Purpose: The aim of this review was to analyze all the current evidence and conclude which factors play a role in increasing or decreasing the risk of anastomotic leakage. Methods: The selection of papers from the Medline database was conducted through the application of the query "(anterior resection rectum) AND (anastomotic leak OR leakage OR fistula OR dehiscence) AND (risk factor OR risk)" on the official search engine (Pubmed). The results were filtered by language, availability of the full text and relevance (type of study, publication date and content). Results and Conclusions: The lack of a consensus regarding definition of leakage and the observational character of most studies justifies contradictory results concerning most of the studied factors. Evidence suggested that probable risk factors are preoperative chemoradiotherapy/radiotherapy, male gender, diabetes mellitus, larger/lower tumour, low anastomosis, surgery performed by a non-specialized surgeon, longer operative time, total mesorectal excision and multiple stapler firings during rectal transection - which should be included in medical decisions. A temporary diverting stoma and a transanal decompression tube seem to mitigate the consequences of leakage, although it is not clear if they reduce its incidence. There is still need for a standard definition of anastomotic leakage and experimental studies regarding most factors.
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