International Journal of Colorectal Disease

, Volume 25, Issue 7, pp 843–849

Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer

  • Ui Sup Shin
  • Chan Wook Kim
  • Chang Sik Yu
  • Jin Cheon Kim
Original Article

DOI: 10.1007/s00384-010-0938-1

Cite this article as:
Shin, U.S., Kim, C.W., Yu, C.S. et al. Int J Colorectal Dis (2010) 25: 843. doi:10.1007/s00384-010-0938-1

Abstract

Purpose

The aim of the present study was to investigate the characteristics of patients who developed delayed anastomotic leakage (DAL) following sphincter-preserving surgery for rectal cancer. We evaluated the following factors: (1) the incidence of DAL, (2) the clinical features of patients who developed DAL, (3) the risk factors for DAL, and (4) treatment outcomes.

Methods

We reviewed the case histories of 1,838 rectal cancer patients who had undergone curative resection with sphincter preservation and without protective stoma formation between January 2000 and December 2006. DAL was defined as the development of a pelvic abscess or fistula around the anastomosis more than 3 weeks post-surgery in patients without tumor recurrence who had resumed a normal diet and defecation.

Results

In 1.3% (24/1,838) of the patients, DAL developed on median postoperative day 99 (range 22–2,069). Pelvic abscess (50%) and anastomotic–vaginal fistula (41.7%) were the most common causes of DAL. Independent risk factors for the development of DAL were: (1) female gender (hazard ratio 3.03; 95% CI 1.06–8.8), (2) low-level anastomosis (≤4 cm from the anal verge) (hazard ratio 5.76; 95% CI 1.37–22.39), and (3) preoperative chemoradiation therapy (hazard ratio 4.56; 95% CI 1.4–14.92). Stoma formation was performed in all of the 24 patients. The 3-year stoma-retention rate in patients with DAL was significantly higher than in patients with early anastomotic leakage (72.2% vs 17.5%, P < 0.001).

Conclusions

DAL following sphincter-preserving surgery for rectal cancer occurred relatively frequently in our sample and was associated with female gender, a low level of anastomosis, and preoperative radiotherapy. DAL patients required long-term or permanent stomas.

Keywords

Rectal cancerDelayed anastomotic leakagePreoperative chemoradiation therapyPelvic abscessRecto-vaginal fistula

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Ui Sup Shin
    • 1
  • Chan Wook Kim
    • 1
  • Chang Sik Yu
    • 1
  • Jin Cheon Kim
    • 1
  1. 1.Department of Colonic and Rectal Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSongpa-guKorea