Definition and grading of anastomotic stricture/stenosis following low anastomosis after total mesorectal excision: A single-center study

Abstract

BACKGROUND: Anastomotic stricture/stenosis is an alarming complication after colorectal surgery, and there is still no recognized definition for anastomotic stricture/stenosis. This study aimed to determine the status and change of anastomotic stricture/stenosis after rectal surgery using a special anastomotic stricture/stenosis definition and grading system, discuss various risk factors for anastomotic stricture/stenosis, and explore the effect of different degrees of anastomotic stricture/stenosis on bowel function. METHODS: This study included patients with confirmed rectal cancer who underwent total mesorectal excision between May 2014 and May 2021. A five-degree special anastomotic stricture/stenosis definition and grading system was used to determine anastomotic stricture/stenosis status, and clinical outcomes and risk factors for anastomotic stricture/stenosis were investigated. Furthermore, the low anterior resection syndrome score was used to assess bowel function. RESULTS: A total of 473 patients were enrolled in this study. The low anterior resection syndrome assessment showed that the more severe the anastomotic stricture/stenosis, the more severe the low anterior resection syndrome (all p<0.001). Univariate and multivariate analyses of patient-related and technical risk factors for anastomotic stricture/stenosis were performed 3 months postoperatively. For univariate analysis, female sex was a lower risk factor for anastomotic stricture/stenosis. Defunctioning stoma, neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were higher risk factors for anastomotic stricture/stenosis (all p<0.05). For multivariate analysis, only neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were still higher risk factors for anastomotic stricture/stenosis (all p<0.05). CONCLUSIONS: Through a special anastomotic stricture/stenosis definition and grading system’s evaluation, we noted the anastomotic stricture/stenosis severity significantly affected bowel function, and multivariate analysis showed that neoadjuvant chemoradiotherapy, chemotherapy, and anastomotic leakage were the higher risk factors for anastomotic stricture/stenosis.