Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer: an analysis of 59 cases

Abstract

Aim The construction of a new coloanal anastomosis (CAA) following anastomotic leakage after low anterior resection (LAR) is challenging. The available literature on this topic is scarce. The aim of this two-centre study was to determine the clinical success and morbidity after redo CAA.Method This retrospective cohort study included all patients with anastomotic leakage after LAR for rectal cancer who underwent a redo CAA between 2010 and 2014 in two tertiary referral centres. Short-and long-term morbidity were analysed, including both anastomotic leakage and permanent stoma rates on completion of follow-up.Results A total of 59 patients were included, of whom 45 (76%) were men, with a mean age of 59 years (SD AE 9.4). The median interval between index and redo surgery was 14 months [interquartile range (IQR) 8-27]. The median duration of follow-up was 27 months . The most frequent complication was anastomotic leakage of the redo CAA occurring in 24 patients (41%), resulting in a median of three reinterventions (IQR 2-4) per patient. At the end of follow-up, bowel continuity was restored in 39/59 (66%) patients. Fourteen (24%) patients received a definitive colostomy and six (10%) still had a diverting ileostomy. In a multivariable model, leakage of the redo CAA was the only risk factor for permanent stoma (OR 0.022; 95% CI 0.004-0.122).Conclusion Redo CAA is a viable option in selected patients with persisting leakage after LAR for rectal cancer who want their bowel continuity restored. However, patients should be fully informed about the relatively high morbidity and reintervention rates.Keywords Redo surgery, rectal cancer, low anterior resection, anastomotic leakage, hand-sewn coloanal anastomosis What does this paper add to the literature? This is one of the largest homogeneous cohort studies on anastomotic leakage after low anterior resection for rectal cancer that is treated with the construction of a new coloanal anastomosis. This study shows that this complex and still quite rare procedure results in moderate success with significant associated morbidity.

Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases

“…Our results suggest an overall success rate of restoring intestinal continuity of 78%. This rate compares favourably with previously published rates of success for redo surgery after failed anastomosis, with reported rates ranging from 66% to 92% , but the rate is lower than the reported success rate of HR, reaching 98% in recent reports . These numbers once again reflect that HR following HP performed for a failure of pelvic anastomosis is probably more difficult than after HP performed for other cause.…”

Tailored treatment of anastomotic leak after rectal cancer surgery according to the presence of a diverting stoma

“…However, surgeons should keep in mind that it can cause further AL with an even higher risk than that at the time of the index surgery. In a study confined to patients who experienced AL, redo anastomosis not only had the lowest success rate (66%) but was also associated with a second AL rate of up to 41% [20]. In this study, a total of 11 (9 in the no diversion group, 2 in the diversion group) redo anastomoses were performed for the acute management of AL, and 8 patients (72.7%) could avoid a permanent stoma.…”

Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors

“…Eleven of these cases had spontaneous healing, but the incidence of recurrent leakage was 46% (6/13). A recent systematic review suggested that redo surgery is a valuable treatment option for a complicated colorectal resection or CAA, with a rate of 79% for successful restoration of bowel continuity . To avoid recurrent leakage, additional treatment options (e.g.…”