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Risk factors affecting benign anastomotic stricture in anterior and low anterior resections for colorectal cancer: a single-center retrospective cohort study

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Abstract

Purpose

Although not as life-threatening as anastomotic leakage, anastomotic stricture reduces the quality of life. The risk factors for such an important life complication have not been revealed. This article examines the risk factors affecting anastomotic strictures due to colorectal cancers.

Methods

Patients who underwent anterior and low anterior resection for colorectal cancer under elective conditions between 2015 and 2021 were included in the study. The patients were divided into two groups, those who developed anastomotic stricture and those who did not. The parameters determined between the two groups were compared, and multivariate analysis of statistically significant parameters was performed.

Results

A total of 375 patients were included in the study. The anastomotic stricture was detected in 36 (9.6%) patients. In the multivariate analysis, non-mobilization of the splenic flexure and a proximal clean surgical margin of < 10 cm and a distal surgical margin of < 2 cm were identified as risk factors affecting anastomotic stricture. The risk factor with the highest odds ratio in the development of anastomotic stricture is the non-mobilization of the splenic flexure (p = 0.001, OR 11.375).

Conclusion

It is recommended that the mobilization of the splenic flexure to reduce the development of strictures. In addition, a clean surgical margin of 10 cm proximally and 2 cm distally and high ligation of the inferior mesenteric artery may reduce the development of stricture.

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Funding

The authors also declare that they have no competing financial interests.

Author information

Authors and Affiliations

  1. Department of General Surgery, Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Genel Cerrahi 4. Kat Zuhuratbaba Mah. Tevfik Sağlam Cd. No: 11 Bakirkoy, Istanbul, Turkey

    Ahmet Surek, Turgut Donmez, Eyup Gemici, Arif Kaya, Sina Ferahman & Mehmet Karabulut

  2. Department of General Surgery, LIV Hospital Ulus and Vadistanbul, Istanbul, Turkey

    Ahmet Cem Dural

  3. Department of General Surgery, Faculty of Medicine, Istinye University, Zeytinburnu, Istanbul, Turkey

    Ahmet Cem Dural

  4. Department of General Surgery, Memorial Hizmet Hospital, Istanbul, Turkey

    Cevher Akarsu

  5. Department of General Surgery, Faculty of Medicine, İstinye University, Bahçeşehir LIV Hospital, Istanbul, Turkey

    Mehmet Abdussamet Bozkurt

  6. Department of General Surgery, Istanbul Aydin University, Istanbul, Turkey

    Halil Alis

Authors
  1. Ahmet Surek
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  2. Turgut Donmez
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  8. Mehmet Abdussamet Bozkurt
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  10. Halil Alis
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Contributions

AS contributed to design and writing of the study. All authors have contributed in data collection, analysis and critical revision.

Corresponding author

Correspondence to Ahmet Surek.

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Disclosures

Ahmet Surek, Turgut Donmez, Eyup Gemici, Ahmet Cem Dural, Cevher Akarsu, Arif Kaya, Sina Ferahman, Mehmet Abdussamet Bozkurt, Mehmet Karabulut and Halil Alis have no conflict of interest or financial ties to disclose.

Ethical approval

The ethics committee approval for the study was obtained from the local ethics committee (Ethics committee approval date: 07.06.2021 Decision no: 2011–11-18).

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Surek, A., Donmez, T., Gemici, E. et al. Risk factors affecting benign anastomotic stricture in anterior and low anterior resections for colorectal cancer: a single-center retrospective cohort study. Surg Endosc 37, 5246–5255 (2023). https://doi.org/10.1007/s00464-023-10002-3

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