International Journal of Colorectal Disease

, Volume 25, Issue 7, pp 843–849 | Cite as

Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer

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



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.


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.


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).


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.


Rectal cancer Delayed anastomotic leakage Preoperative chemoradiation therapy Pelvic abscess Recto-vaginal fistula 


  1. 1.
    Cohen Z, Myers E, Langer B, Taylor B, Railton RH, Jamieson C (1983) Double stapling technique for low anterior resection. Dis Colon Rectum 26:231–235CrossRefPubMedGoogle Scholar
  2. 2.
    Choi PW, Jung SH, Kim JR, Yu CS, Kim HS, Kim JC (2006) Trend of clinicopathologic characteristics of colorectal cancer in Asan Medical Center: a 15-year experience. J Korean Soc Coloproctol 22:387–395Google Scholar
  3. 3.
    Enker WE, Merchant N, Cohen AM, Lanouette NM, Swallow C, Guillem J, Paty P, Minsky B, Weyrauch K, Quan SH (1999) Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg 230:544–552, Discussion 552-544CrossRefPubMedGoogle Scholar
  4. 4.
    Law WI, Chu KW, Ho JW, Chan CW (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96CrossRefPubMedGoogle Scholar
  5. 5.
    Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214CrossRefPubMedGoogle Scholar
  6. 6.
    Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358CrossRefPubMedGoogle Scholar
  7. 7.
    Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113PubMedGoogle Scholar
  8. 8.
    Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469CrossRefPubMedGoogle Scholar
  9. 9.
    Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN (2005) Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 7:51–57CrossRefPubMedGoogle Scholar
  10. 10.
    Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, Kim JC (2008) Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum 51:902–908CrossRefPubMedGoogle Scholar
  11. 11.
    Hallbook O, Sjodahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83:60–62CrossRefPubMedGoogle Scholar
  12. 12.
    Nesbakken A, Nygaard K, Lunde OC (2001) Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 88:400–404CrossRefPubMedGoogle Scholar
  13. 13.
    Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266CrossRefPubMedGoogle Scholar
  14. 14.
    Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, Bokey EL (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240:255–259CrossRefPubMedGoogle Scholar
  15. 15.
    Kasperk R, Philipps B, Vahrmeyer M, Willis S, Schumpelick V (2000) Risk factors for anastomosis dehiscence after very deep colorectal and coloanal anastomosis. Chirurg 71:1365–1369CrossRefPubMedGoogle Scholar
  16. 16.
    Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142CrossRefPubMedGoogle Scholar
  17. 17.
    Marusch F, Koch A, Schmidt U, Wenisch H, Ernst M, Manger T, Wolff S, Pross M, Tautenhahn J, Gastinger I, Lippert H (2002) Early postoperative results of surgery for rectal carcinoma as a function of the distance of the tumor from the anal verge: results of a multicenter prospective evaluation. Langenbecks Arch Surg 387:94–100CrossRefPubMedGoogle Scholar
  18. 18.
    Moran BJ, Heald RJ (2001) Risk factors for, and management of anastomotic leakage in rectal surgery. Colorectal Dis 3:135–137CrossRefPubMedGoogle Scholar
  19. 19.
    Heald RJ, Leicester RJ (1981) The low stapled anastomosis. Dis Colon Rectum 24:437–444CrossRefPubMedGoogle Scholar
  20. 20.
    Smith LE (1981) Anastomosis with EEA stapler after anterior colonic resection. Dis Colon Rectum 24:236–242CrossRefPubMedGoogle Scholar
  21. 21.
    Fleshner PR, Schoetz DJ Jr, Roberts PL, Murray JJ, Coller JA, Veidenheimer MC (1992) Anastomotic–vaginal fistula after colorectal surgery. Dis Colon Rectum 35:938–943CrossRefPubMedGoogle Scholar
  22. 22.
    Lee RC, Rotmensch J (2004) Rectovaginal radiation fistula repair using an obturator fasciocutaneous thigh flap. Gynecol Oncol 94:277–282CrossRefPubMedGoogle Scholar
  23. 23.
    Kosugi C, Saito N, Kimata Y, Ono M, Sugito M, Ito M, Sato K, Koda K, Miyazaki M (2005) Rectovaginal fistulas after rectal cancer surgery: Incidence and operative repair by gluteal-fold flap repair. Surgery 137:329–336CrossRefPubMedGoogle Scholar
  24. 24.
    Kuzu MA, Koksoy C, Akyol FH, Uzal D, Kale IT (1999) Colonic anastomotic healing after preoperative chemo-radiotherapy in rat. Radiat Med 17:181–187PubMedGoogle Scholar
  25. 25.
    Terzi C, Sevinc AI, Kocdor H, Oktay G, Alanyali H, Kupelioglu A, Ergor G, Fuzun M (2004) Improvement of colonic healing by preoperative rectal irrigation with short-chain fatty acids in rats given radiotherapy. Dis Colon Rectum 47:2184–2194CrossRefPubMedGoogle Scholar

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

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