Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Abstract

The purpose of this article is to identify the risk factors for local recurrence and anastomotic leakage after sphincter-sparing surgery for low and mid rectal cancer. Material and We prospectively analyzed a group of 38 patients with low and middle rectal cancer who underwent sphincter-sparing surgery. Low anterior resection was performed in 32 cases (84.2%) and 6 cases (15.8%) benefited of ultralow anterior resection. Clinical stadialization cTNM included 3 patients (7.9%) T1 stage, 11 patients (28.9%) T2 stage and 24 patients (63.2%) T3 stage. Preoperative radiotherapy was performed in 33 cases (86.4%), and chemotherapy was associated in 20 cases (52.6%). The stages I and II cancers were prevalent (63.2%), followed by stage III cancers (23.7%) and stage IV cancers (13.2%). The rate of complications of 52.6% (20 cases) was associated with T3 stage cancers. Anastomotic leakage has occurred in 4 cases (10.5%) and tumor recurrence has developed in 3 cases (7.9%). The rate of local recurrence and anastomotic leakage is associated with the number of positive lymph nodes (more than 4 nodes, 5.3%, p = 0.023). We found no association between chemoradiotherapy and the risk of local recurrence (p 0.05). Other postoperative complications included intestinal obstruction by adhesions or bowel volvulus (5 cases, 13.2%), postradiation colitis (3 cases, 7.7%), coloanal anastomotic stenosis (1 case, 2.6%), rectovaginal fistula (1 case, 2.6%), ileostomy bleeding (1 case, 2.6%), wound infection (2 cases, 5.3%). Risk factors associated with local recurrence and anastomotic leakage are aggressive stage tumor, lymphnodes involvement, neoadjuvant therapy and postoperative anemia. The postoperative outcome was favorable after sphincter preservation surgery and the absence of definitive colostomy had an important impact on the quality of life of the patients with distal rectal cancer.

Latest Advances in Intersphincteric Resection for Low Rectal Cancer

“…Aggressive stage tumour, lymph node involvement, PCRT, and postoperative anemia are risk factors related to AL [ 41 ]. Besides the technical difficulties of anastomosis during operation, a predominant reason is the lack of blood supply after TME.…”

“…The local recurrence rate following sphincter-saving resections for low rectal cancer has been reported to range from 4% to 13% [ 58 ], and the 5-year local recurrence rate is not significantly different from that of low anterior resection (LAR) and ARP [ 7 ]. Local recurrence is related to pathological stage, local dedifferentiation, incision margin under microscope, postoperative anemia [ 41 ], and serum CA 19-9 level before operation [ 59 ]. Among them, CRM involvement is the most critical predictor.…”

“…In addition to direct clinical consequences such as intra-abdominal or pelvic abscess, peritonitis, septicemia, prolonged hospitalization, and increased mortality, AL also induces pelvic organ dysfunction, anal dysfunction [39], local cancer recurrence, and increased cancer specific mortality [40]. Aggressive stage tumour, lymph node involvement, PCRT, and postoperative anemia are risk factors related to AL [41]. Besides the technical difficulties of anastomosis during operation, a predominant reason is the lack of blood supply after TME.…”