Anastomotic leakage after anterior resection in patients with rectal cancer previously irradiated for prostate cancer

Abstract

Introduction: There are little data on the post-operative outcome of anterior resection (AR) for rectal cancer in men who had received radiotherapy for prostate cancer previously. The aim of this study was to assess the rate of anastomotic leakage (AL) after AR in these patients. Methods: All men who underwent bowel resection because of rectal cancer between 2000 and 2016 and had been diagnosed previously with prostate cancer were identified by linking the Swedish Colorectal Cancer Registry with the National Prostate Cancer Register. The medical records of men who underwent AR and had previously received radiotherapy for prostate cancer were reviewed. Results: In total, 13299 men had undergone a bowel resection for rectal cancer, 188 of whom had previously received radiotherapy for prostate cancer. Among those who had received radiation therapy, 59 men (31%) had an AR: 50 men (85%) received a diverting ileostomy, 42 men (71%) had an American Society of Anesthesiologists score of 1e2 and 36 men (61%) had tumour stage 1e2. AL was found in 12/59 men (20%), one of whom had a re-laparotomy. There was no 90-day mortality. Conclusions: In the combined national population-based registries, a minority of patients with rectal cancer had an AR after previous radiotherapy for prostate cancer. These patients were healthy with early cancer stages and, in this selected group of patients, the AL rate was much lower than that reported previously.

Is it safe to perform an anastomosis for rectal cancer after prostate cancer? A multicentre study of 126 patients from the GRECCAR group

“…Regarding the available literature focused on RS in the setting of previously treated PC, three other studies have been recently published reporting AL rates ranging from 10% to 62.5% [15,16,25].…”

“…Regarding the available literature focused on RS in the setting of previously treated PC, three other studies have been recently published reporting AL rates ranging from 10% to 62.5% [15,16,25]. While these results are quite conflicting, this raises the question of the heterogeneity between these cohort studies.…”

“…Managing RC in the setting of previously treated PC remains challenging. Morbidity is indeed increased owing to a higher risk of AL [5,15,16]. The current multicentre study included 126 patients who underwent a rectal resection after a previous treatment for PC (RT and/or radical prostatectomy).…”

Intraoperative indocyanine green fluorescence angiography to prevent anastomotic leak after low anterior resection for rectal cancer: a meta‐analysis

“…Anastomotic leakage (AL) is one of the most dreadful complications after sphincter‐sparing procedures for rectal cancer. The leak rates are found to be much higher (9–24%)3 with colorectal/coloanal anastomosis in rectal cancer surgery comparing to those (10–13%)5 with ileocolonic/colonic anastomosis in colon cancer surgery. Although minor AL could be managed by antibiotics and conservative methods, symptomatic AL usually requires emergency surgery, increases morbidity, prolongs post‐operative hospital stay and becomes life threatening when general peritonitis or sepsis occurs 6.…”

Left colic artery diameter is an important factor affecting anastomotic blood supply in sigmoid colon cancer or rectal cancer surgery: a pilot study

“…One of the most serious complications of colorectal cancer surgery is anastomotic leakage. It occurs in 1 to 30% of all cases [1][2][3][4], with the highest rate (of up to 20%) reported for rectal anastomotic leakage [5]. An anastomotic fistula seriously affects patients' quality of life, prognosis, and hospitalization costs and increases the risk of death [6,7].…”