Late anastomotic leakage after anal sphincter saving surgery for rectal cancer: is it different from early anastomotic leakage?

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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Affiliations

Authors

Contributions

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

Corresponding author

Correspondence to Nam Kyu Kim.

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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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Keywords

  • Rectal cancer
  • Sphincter saving surgery
  • Anastomotic leakage
  • Neoadjuvant chemoradiotherapy