The fate of anastomotic sinuses after total mesorectal excision for rectal cancer

Abstract

Objective Chronic anastomotic sinus is a recognized complication of total mesorectal excision (TME) surgery. We observed two patients who developed new tumours within chronic anastomotic sinuses 6 and 19 years after initial surgery. The aim of this study was therefore to report the incidence and outcome of anastomotic sinuses, thus identifying those at potential risk of malignant change.Method We retrospectively reviewed patient records and radiology reports to identify potentially curative rectal cancer cases between 1998 and 2005.Results In a consecutive series of 100 TMEs with ileostomy, there were 70 males and 30 females, aged 66 (33-88) years. Anastomosis was by double staple technique. A policy of instant enema was used prior to ileostomy closure. Eighty-six patients had instant enemas. Of the 14 that did not, four died prior to enema, one returned to theatre for sepsis, three had their anastomoses assessed by sigmoidoscopy alone. Six had incomplete records. Of the 86 patients, eight presacral sinuses were identified. Three sinuses closed spontaneously. Five persisted of whom two required further surgery.Conclusion Persistent anastomotic sinuses occurred in 5% after curative TME. Malignant transformation can occur. Active treatment for chronic sinuses should, therefore, be considered.

Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

“…A permanent stoma because of the anastomotic leakage is even more distressing for the patient. Earlier studies have shown that anastomotic leakage after anterior resection has a higher probability of permanent stoma formation with stoma reversal possible in only 33 % patients who required stoma creation for the anastomotic leakage in one of the series [8,9]. In the present series, successful stoma reversal was possible in 53 % patients.…”

“…Oncologically, those who develop anastomotic leakage, particularly those who require reintervention, have been found to have higher incidence of local recurrence and inferior overall survival [6,7]. Functionally, it has been observed that anastomotic leakage carries high probability of permanent stoma [8,9].…”

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

“…Possibly surgeons apply other techniques for local control of extraperitoneal abscesses like radiological drainage, marsupialisation and endosponge. Although these new techniques seem promising, they also have their drawbacks [25,26]. These options were not offered in our questionnaire, since it is considered common surgical practice to treat a minor leak with an adjacent abscess with radiological drainage with or without diversion.…”

Postoperative and Long-term Outcomes After Redo Surgery for Failed Colorectal or Coloanal Anastomosis

“…2 Despite all conservative medical or surgical measures, 1% to 5% of patients with low CRa or Caa develop chronic anastomotic leakage resulting in recurrent abscesses, abdominal pain, and anal soiling. [3][4][5] in addition, chronic strictures occur in 3% to 30% of patients after low CRa or Caa, depending on the definition adopted, and such strictures may lead to stool fragmentation, abdominal pain and distension, bloating, constipation, false diarrhea, or ribbon stools. 6,7 failed CRa or Caa may necessitate a permanent stoma 8,9 and result in poor quality of life, including psychological sequelae, deterioration of body image, decrease in physical well-being, and social restriction.…”