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Are risk factors for anastomotic leakage influencing long-term oncological outcomes after low anterior resection of locally advanced rectal cancer with neoadjuvant therapy? A single-centre cohort study

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Abstract

Purpose

Anastomotic leakage (AL) poses the most serious problem following low anterior resection in patients with rectal cancer independent of surgical approach or technique. The aim of this study was to evaluate risk factors for the occurrence of AL and how they affect the oncological long-term outcome of patients who received neoadjuvant therapy.

Methods

A single centre cohort study of 163 consecutive locally advanced rectal cancer patients (cT3, cT4, N +) that received neoadjuvant therapy followed by resection with primary anastomosis between January 1998 and December 2020 were included in this study. Short- and long-term findings were compared between patients with AL (Leakage +) and without AL (Leakage −).

Results

A complete follow-up was obtained from 163 patients; thereby, 33 patients (20%) developed an AL. We observed more patients with comorbidities (38% vs. 61%, p = 0.049) which developed a leakage in the course. Permanent stoma rate (36% vs. 18%, p = 0.03) was higher, and time between primary operation and stoma reversal was longer (219 days [172–309] vs. 93 days [50–182], p < 0.001) in this leakage group as well. Tumour distance lower than 6 cm from the anal verge (OR: 2.81 [95%CI: 1.08–7.29], p = 0.04) and comorbidities (OR: 2.22 [95%CI: 1.01–4.90], p = 0.049) was evaluated to be independent risk factors for developing an AL after rectal cancer surgery. Oncological outcome was not influenced by AL nor by other associated risk factors.

Conclusion

We could clearly detect the distance of tumour from the anal verge and comorbidities independent risk factors for the occurrence of AL. Oncological findings and long-term outcome were not influenced by these particular risk factors.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

TME:

Total mesorectal excision

AL:

Anastomotic leakage

LAR:

Low anterior resection

DS:

Defunctioning stoma

BMI:

Body mass index

ASA:

American Society of Anaesthesiologists

CRT:

Chemoradiation therapy

CEA:

Carcinoembryonic antigen

UICC:

Union for International Cancer Control

MRI:

Magnet resonance imaging

CT:

Computer tomography

WBC:

White blood cells

Hb:

Haemoglobin

CRP:

C-reactive protein

DFS:

Disease-free survival

OS:

Overall survival

APR:

Abdomino perineal resection

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Authors and Affiliations

  1. Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria

    Peter Tschann, Markus P. Weigl, Daniel Lechner, Thomas Brock, Stephanie Rauch, Jana Rossner, Paolo N. C. Girotti & Ingmar Königsrainer

  2. Institute of Medical Physics, Academic Teaching Hospital, Feldkirch, Austria

    Philipp Szeverinski & Alexander De Vries

  3. Department of Radio-Oncology, Academic Teaching Hospital, Feldkirch, Austria

    Helmut Eiter & Patrick Clemens

  4. Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria

    Tarkan Jäger, Jaroslav Presl & Klaus Emmanuel

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  1. Peter Tschann
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Contributions

PT, MW, PS, DL, TB, SR, JR, HE, PG, TJ, JP, KE, AV, IK, and PC designed the study. Collection of data was done by HE, PT, JR, and MW. PT wrote the manuscript and prepared the tables. PS and PT did the statistical analysis. All authors contributed toward data acquisition, data interpretation, and critical revision of the content of the manuscript and approved the final version of the manuscript.

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Correspondence to Peter Tschann.

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This study was presented to the Ethics Committee of the Province of Vorarlberg and does not require any referral or vote by this committee (EK-0.04–391).

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Tschann, P., Weigl, M.P., Szeverinski, P. et al. Are risk factors for anastomotic leakage influencing long-term oncological outcomes after low anterior resection of locally advanced rectal cancer with neoadjuvant therapy? A single-centre cohort study. Langenbecks Arch Surg 407, 2945–2957 (2022). https://doi.org/10.1007/s00423-022-02609-2

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