ALB and chronic obstructive pulmonary disease: All four patients, including one patient who had undergone bowel resection, with major leakage had (1) American Society of Anaesthesiologists score ≥ 3 points with coronary artery disease or chronic obstructive pulmonary disease, (2) cancer recurrence, (3) serum albumin level < 3.3 g/dL at the time of button jejunostomy removal, and (4) heavy smoking history.