Anastomotic leakage and presacral abscess formation after locally advanced rectal cancer surgery: Incidence, risk factors and treatment

Abstract

Purpose of the study: Anastomotic leakage (AL) and presacral abscess (PA) after rectal cancer surgery are a major concern for the colorectal surgeon. In this study, incidence, prognosis and treatment was assessed.

Methods: Patients operated on in our institute, between 1994 and 2011, for locally advanced rectal cancer (LARC, T3+/T4M0) were included. Morbidity was scored using the Clavien-Dindo classification. Prognostic factors were analysed using binary logistic regression.

Results: 517 patients were included after a low anterior resection (n = 219) or abdominoperineal resection (n = 232). AL occurred in 25 patients (11.4%); 50 patients (9.7%) developed a PA. We identified intraoperative blood loss ≥4500 cc (p = 0.038) and the era of surgery; patients operated on before the year 2006 (p = 0.042); as risk factors for AL. The time between last day of neo-adjuvant treatment and surgery, <8 weeks is significantly associated with the development of PA (p = 0.010).

Conclusions: In our population of LARC patients we found an incidence of 9.7% PA and 11.4% AL, with a 12% mortality rate for AL, which is comparable to surgery in general colorectal cancer. Increased intraoperative blood loss and surgery prior to 2006 are associated with AL. Increased intraoperative blood loss and a timing interval <8 weeks increases the risk of PA formation.

Keywords: Anastomotic leakage; Locally advanced rectal cancer; Presacral abscess; Treatment.