Abstract
Purpose
Although multiple studies have examined anastomotic leakage (AL) after low anterior resection (LAR), their definitions of AL varied, and few have studied late diagnosed AL after surgery. This study aimed to characterize late AL after anal sphincter saving surgery (SSS) for rectal cancer by examining clinical characteristics, risk factors, and management of patients with late AL compared with early AL.
Methods
Data from January 2005 to December 2014 were collected from a total of 1903 consecutive patients who underwent anal sphincter saving surgery for rectal cancer and were retrospectively reviewed. Late AL was defined as AL diagnosed more than 30 days after surgery. Variables and risk factors associated with early and late diagnosed AL were analyzed by multivariate logistic regression.
Results
Overall, early, and late rates of AL were 13.7%, 6.7%, and 7%, respectively. Receiving neoadjuvant chemoradiotherapy (nCRT) was a risk factor for developing late AL, but not early AL (OR, 3.032; 95% CI, 1.947–4.722; p < 0.001). Protective ileostomy did not protect against late AL. Among the 134 patients with late AL, 26 (19.4%) were classified as asymptomatic and 108 patients (80.6%) as symptomatic. The most frequent symptomatic complications related to late AL were fistula (42 cases, 39.7%), chronic sinus (33 cases, 31.1%), and stenosis (31 cases, 29.2%).
Conclusion
Clinical characteristics, risk factors, and management of patients with late AL after SSS were different from early AL. Close attention should be given to consider late AL as the continuation of early AL.
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References
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482
Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355(11):1114–1123
Rullier E, Zerbib F, Laurent C, Bonnel C, Caudry M, Saric J, Parneix M (1999) Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum 42(9):1168–1175
Marks G, Mohiuddin M, Eitan A, Masoni L, Rakinic J (1991) High-dose preoperative radiation and radical sphincter-preserving surgery for rectal cancer. Arch Surg 126(12):1534–1540
Swellengrebel HA, Marijnen CA, Verwaal VJ, Vincent A, Heuff G, Gerhards MF, van Geloven AA, van Tets WF, Verheij M, Cats A (2011) Toxicity and complications of preoperative chemoradiotherapy for locally advanced rectal cancer. Br J Surg 98(3):418–426
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(2):207–214
Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, Rutten HJ, van de Velde CJ (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92(2):211–216
Boccola MA, Buettner PG, Rozen WM, Siu SK, Stevenson AR, Stitz R, Ho YH (2011) Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 35(1):186–195
Kim CW, Baek SJ, Hur H, Min BS, Baik SH, Kim NK (2016) Anastomotic leakage after low anterior resection for rectal Cancer is different between minimally invasive surgery and open surgery. Ann Surg 263(1):130–137
Chang JS, Keum KC, Kim NK, Baik SH, Min BS, Huh H, Lee CG, Koom WS (2014) Preoperative chemoradiotherapy effects on anastomotic leakage after rectal cancer resection: a propensity score matching analysis. Ann Surg 259(3):516–521
Jang JH, Kim HC, Huh JW, Park YA, Cho YB, Yun SH, Lee WY, Yu JI, Park HC, Park YS, Park JO (2017) Anastomotic leak does not impact oncologic outcomes after preoperative chemoradiotherapy and resection for rectal cancer. Ann Surg 269:678–685. https://doi.org/10.1097/sla.0000000000002582
Qin C, Ren X, Xu K, Chen Z, He Y, Song X (2014) Does preoperative radio(chemo)therapy increase anastomotic leakage in rectal cancer surgery? A meta-analysis of randomized controlled trials. Gastroenterol Res Pract 2014:910956
Qin Q, Ma T, Deng Y, Zheng J, Zhou Z, Wang H, Wang L, Wang J (2016) Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection: post hoc analysis of a randomized controlled trial. Dis Colon Rectum 59(10):934–942
Borstlap WAA, Westerduin E, Aukema TS, Bemelman WA, Tanis PJ (2017) Anastomotic leakage and chronic presacral sinus formation after low anterior resection: results from a large cross-sectional study. Ann Surg 266(5):870–877
Lim SB, Yu CS, Kim CW, Yoon YS, Park IJ, Kim JC (2016) Late anastomotic leakage after low anterior resection in rectal cancer patients: clinical characteristics and predisposing factors. Color Dis 18(4):O135–O140
Jutesten H, Draus J, Frey J, Neovius G, Lindmark G, Buchwald P, Lydrup ML (2017) Late leakage after anterior resection: a defunctioning stoma alters the clinical course of anastomotic leakage. Color Dis 20:150–159. https://doi.org/10.1111/codi.13914
Morks AN, Ploeg RJ, Sijbrand Hofker H, Wiggers T, Havenga K (2013) Late anastomotic leakage in colorectal surgery: a significant problem. Color Dis 15(5):e271–e275
Floodeen H, Hallbook O, Rutegard J, Sjodahl R, Matthiessen P (2013) Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities? Color Dis 15(3):334–340
Arumainayagam N, Chadwick M, Roe A (2009) The fate of anastomotic sinuses after total mesorectal excision for rectal cancer. Color Dis 11(3):288–290
Snijders HS, Bakker IS, Dekker JW, Vermeer TA, Consten EC, Hoff C, Klaase JM, Havenga K, Tollenaar RA, Wiggers T (2014) High 1-year complication rate after anterior resection for rectal cancer. J Gastrointest Surg 18(4):831–838
Hain E, Maggiori L, Manceau G, Zappa M, Prost a la Denise J, Panis Y (2016) Persistent asymptomatic anastomotic leakage after laparoscopic sphincter-saving surgery for rectal cancer: can diverting stoma be reversed safely at 6 months? Dis Colon Rectum 59(5):369–376
den Dulk M, Smit M, Peeters KC, Kranenbarg EM, Rutten HJ, Wiggers T, Putter H, van de Velde CJ (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8(4):297–303
Benson AB 3rd, Bekaii-Saab T, Chan E et al (2012) Rectal cancer. J Natl Compr Cancer Netw 10(12):1528–1564
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Büchler MW (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the international study group of rectal cancer. Surgery 147(3):339–351
Ambrosetti P, Francis K, De Peyer R, Frossard JL (2008) Colorectal anastomotic stenosis after elective laparoscopic sigmoidectomy for diverticular disease: a prospective evaluation of 68 patients. Dis Colon Rectum 51(9):1345–1349
Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44(10):1464–1468
Figueiredo MN, Mege D, Maggiori L, Ferron M, Panis Y (2015) When is the best time for temporary stoma closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients. Tech Coloproctol 19(8):469–474
Thornton FJ, Barbul A (1997) Healing in the gastrointestinal tract. Surg Clin North Am 77(3):549–573
Shin US, Kim CW, Yu CS, Kim JC (2010) Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer. Int J Color Dis 25(7):843–849
Fong SS, Chen K, Sim R (2011) Chronic anastomotic sinus after low anterior resection: when can the defunctioning stoma be reversed? Color Dis 13(6):644–649
Matthiessen P, Hansson L, Sjodahl R, Rutegard J (2010) Anastomotic-vaginal fistula (AVF) after anterior resection of the rectum for cancer--occurrence and risk factors. Color Dis 12(4):351–357
Park EJ, Baik SH, Kang J, Hur H, Min BS, Lee KY, Kim NK (2016) The impact of postoperative complications on long-term oncologic outcomes after laparoscopic low anterior resection for rectal cancer. Medicine (Baltimore) 95(14):e3271
Yang SY, Han J, Han YD, Cho MS, Hur H, Lee KY, Kim NK, Min BS (2017) Intraoperative colonoscopy for the assessment and prevention of anastomotic leakage in low anterior resection for rectal cancer. Int J Color Dis 32(5):709–714
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SYY: Study idea, data collection and analysis, and manuscript writing
YDH: Data collection and critical review
MSC: Data collection and critical review
HH: Data collection and critical review
BSM: Data collection and critical review
KYL: Data collection and critical review
NKK: Study idea, design, data collection and analysis, and writing manuscript
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Yang, S.Y., Han, Y.D., Cho, M.S. et al. Late anastomotic leakage after anal sphincter saving surgery for rectal cancer: is it different from early anastomotic leakage?. Int J Colorectal Dis 35, 1321–1330 (2020). https://doi.org/10.1007/s00384-020-03608-9
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DOI: https://doi.org/10.1007/s00384-020-03608-9