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The impact of multiple firings on the risk of anastomotic leakage after minimally invasive restorative rectal cancer resection and the impact of anastomotic leakage on long-term survival: a population-based study

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Abstract

Purpose

The aim of this study was to evaluate the anastomotic leakage (AL) rate and predictors for AL following minimally invasive restorative rectal resection (RRR) among rectal cancer patients managed according to up-to-date standardized treatment. Furthermore, we explored the impact of symptomatic AL on long-term survival.

Methods

The study cohort was rectal cancer patients undergoing minimally invasive RRR in Central Denmark Region between 2013 and 2017. Data was retrieved from a prospective clinical quality database and supplemented with data from medical records. The AL rate was calculated as the proportion of patients who developed symptomatic AL within 30 days. Predictors for AL were identified through logistic regression. The impact of AL on long-term survival was analyzed using Kaplan–Meier methods and Cox regression.

Results

AL occurred in 15.1% of 604 patients. The AL rate for males was 20.1% (95% CI 16.3–24.3) and 5.0% (95% CI 2.4–9.0) for females. Odds ratio (OR) of AL in females vs. males was 0.25 (95% CI 0.12–0.51). The use of at least three firings when transecting the rectum was associated with OR of 2.71 (95% CI 1.17–6.26) for AL. The 5-year survival for patients with vs. those without AL was 76.1% (95%CI 65.1–84.0) and 83.6% (95%CI 79.8–86.7), corresponding to adjusted hazard ratio of 1.43 (95%CI 0.84–2.41).

Conclusion

Symptomatic AL is still a challenge in a standardized setting using minimally invasive surgery in rectal cancer patients undergoing RRR, especially in men. Multiple firings should be avoided in transection of the rectum with an endoscopic stapler. AL had a statistical non-significant negative impact on survival.

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Data availability

The data that support the findings of this study are available from Central Denmark Region but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of The Danish Data Protection Agency, Danish Patient Safety Authority, and Central Denmark Region.

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Funding

This study was funded by the Danish Cancer Society. Grant number R204-A12668. The funders had no impact in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 35, 8200, Aarhus N, Denmark

    Jacob Damgaard Eriksen, Troels Nørgaard Bachmann & Lene Hjerrild Iversen

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Jacob Damgaard Eriksen & Lene Hjerrild Iversen

  3. Department of Surgery, Randers Regional Hospital, Randers, Denmark

    Jacob Damgaard Eriksen, Katrine Jøssing Emmertsen & Rune Erichsen

  4. Department of Surgery, Regional Hospital West Jutland, Herning, Denmark

    Anders Husted Madsen

  5. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

    Rune Erichsen

  6. Danish Colorectal Cancer Group, Copenhagen, Denmark

    Lene Hjerrild Iversen

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  1. Jacob Damgaard Eriksen
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  2. Katrine Jøssing Emmertsen
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Correspondence to Jacob Damgaard Eriksen.

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The study was approved by The Danish Data Protection Agency (j.nr. 1–16-02–951-17) and Danish Patient Safety Authority (case number 3–3013-3006/1).

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The authors declare no competing interests.

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Damgaard Eriksen, J., Emmertsen, K.J., Madsen, A.H. et al. The impact of multiple firings on the risk of anastomotic leakage after minimally invasive restorative rectal cancer resection and the impact of anastomotic leakage on long-term survival: a population-based study. Int J Colorectal Dis 37, 1335–1348 (2022). https://doi.org/10.1007/s00384-022-04171-1

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