Long term outcome of anastomotic leakage in patients undergoing low anterior resection for rectal cancer

Abstract

Background: The influence of anastomotic leakage (AL) on local recurrence rates and survival in rectal cancer remains controversial. The aim of this study was to analyze the effect of asymptomatic anastomotic leakage (AAL) and symptomatic anastomotic leakage (SAL) on short-and long-term outcome after curative rectal cancer resection. Methods: All patients who underwent surgical resection of non-metastatic rectal cancer with curative intent from January 2005 to December 2017 were retrospectively analyzed. Short-term morbidity, long-term functional and oncological outcomes were compared between patients with SAL, AAL and without AL (WAL). Results: Overall, 200 patients were included and AL was observed in 39 (19.5%) patients (10 AAL and 29 SAL) with a median follow-up of 38.5 months. Rectal cancer location and preoperative neoadjuvant treatment was similar between the three groups. Postoperative 30-day mortality rate was nil. The permanent stoma rate was higher in patients with SAL or AAL compared to WAL patients (44.8 and 30% vs 9.3%, p < 0.001). The mean wexner continence grading scale was significantly different between AAL (11,4 ± 3,8), SAL (10,3 ± 0,6) and WAL (6,4 ± 4,7) groups (p = 0.049). The 3 and 5year overall and disease-free survival rates were similar between the 3 groups (86.6% /84% vs 100%/100% vs 76%/70 and 82.9%/77% vs 100%/100% vs 94.7%/88.3% for patients with SAL, AAL, and WAL, p = 0.480 and p = 0.527). Conclusion: The permanent stoma rate was significant higher in patients with SAL or AAL compared to WAL patients. AL did not impair long-term oncological outcome.

Simultaneous or Staged Resection for Synchronous Liver Metastasis and Primary Rectal Cancer: A Propensity Score Matching Analysis

“…For rectal surgery, laparoscopic approach was the standard approach. For T4 tumors, open approach was preferred [31]. A medial-to-lateral approach was used.…”

“…A medial-to-lateral approach was used. Specimens were retrieved from abdominal cavity via a small abdominal incision [31]. Mechanical colorectal or manual colo-anal anastomoses (side-to-end or end-to-end) were performed depending on tumor level.…”

“…Pathology results (Table 4) Rectal tumours were mainly T3 (70%) and N1 (45.7%) with medians of 25 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) harvested lymph nodes and 1 lymph node metastasis. There was a median of two liver metastases resected, rectal and liver margins were positive in 11.4% and 24.3% respectively.…”

Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis

“…AL is one of the common postoperative complications of rectal cancer. It has been reported that AL increases the risk of systemic, peritoneal, and local recurrence of CRC [ 12 , 13 ], and the possible mechanism is that the inflammatory reaction results in an increase in proinflammatory and proangiogenic factors, which may stimulate the growth of residual tumor cells. In addition, inflammation caused by AL contributes to tumor escape immune surveillance by suppressing T cell [ 14 , 15 ].…”

Nomogram for Predicting Anastomotic Leakage after Rectal Cancer Surgery in Elderly Patients with Dysfunctional Stomata

“…AL not only causes serious perioperative consequences, such as pelvic abscesses, peritonitis, septic shock, and even death, but is also the main risk factor of long-term complications, such as postoperative anastomotic stenosis and bowel dysfunction. 4 , 5 Although surgical techniques and technologies and perioperative care have greatly evolved over the last several decades, AL is still the main challenge, especially for elderly patients. Compared with open surgery, laparoscopic surgery can significantly reduce the incidence of AL; however, there is no difference in the AL incidence between the techniques.…”