Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019;87(6):611-618.
doi: 10.24875/CIRU.19000531.

Late anastomotic leakages in rectal surgery: a wake-up call about their impact on long-term results

Carlos Placer  1 , Juan Vega  2 , Ignacio Aguirre  1 , Steffen Rose  1 , Yolanda Saralegui  1 , José M Enríquez-Navascués  1
Affiliations

Late anastomotic leakages in rectal surgery: a wake-up call about their impact on long-term results

Carlos Placer et al. Cir Cir. 2019.

Abstract
in English, Spanish

Objective: To assess the impact of the incidence of late anastomotic dehiscences, defined as those occurring after the 60th post-operative day, in the final results of rectal cancer treatment.

Methods: A retrospective analysis was performed reviewing all anastomotic leakages (AL) recorded in a prospective rectal cancer database, from November 2006 to December 2015.

Results: The analysis included 395 (71.5%) colo-rectal anastomosis performed in 552 patients undergoing rectal cancer surgery. Overall 32 (8.1%). AL were identified: 25 (78%) early and 7 (22%) late. Late AL compared to early AL were significantly associated with: higher ASA score (p = 0.021), higher CLS score (p = 0.005), lower rectal tumours (p = 0.014), neo-adjuvant radio-chemotherapy (p = 0.028), presence of ileostomy (p = 0.013), early hospital discharge (p = 0.048) and with the need for definitive stoma creation (p = 0.003).

Conclusions: Late AL can represent up to 22% of all AL; with significant long-term implications such as an increase of the requirement of definitive stoma or chronic pelvic sepsis. This findings could modify the long-term outcomes in rectal cancer published. In our experience, the late AL do not represent a distinct clinical process compared to early forms, with exception of the chronological criteria.

Objetivo: Valorar el impacto de la incidencia de dehiscencias anastomóticas tardías, definidas como las aparecidas después del día 60 del posoperatorio, en los resultados finales del tratamiento del cáncer de recto.

Método: Estudio retrospectivo de todas las dehiscencias anastomóticas recogidas a largo plazo en un registro prospectivo de cáncer de recto entre noviembre de 2006 y diciembre de 2015.

Resultados: Se realizaron 395 anastomosis colorrectales en 552 pacientes con cáncer de recto (71.5%) y se diagnosticaron 32 dehiscencias anastomóticas (8.1%): 25 precoces (78%) y 7 tardías (22%). Las tardías se diferenciaron de las precoces por presentarse en pacientes con mayor puntuación ASA (p = 0.021), mayor puntuación predictiva CLS (p = 0.005), tumores más bajos (p = 0.014), neoadyuvancia (p = 0.028), ileostomía (p = 0.013), menos tiempo de estancia posoperatoria (p = 0.048) y mayor necesidad de estomas definitivos (p = 0.003).

Conclusiones: Las dehiscencias anastomóticas tardías pueden suponer el 22% de las dehiscencias totales y se acompañan de un aumento de estomas definitivos y de sepsis pélvica crónica que podrían empeorar los estándares publicados en cáncer de recto. En nuestra experiencia no son diferentes de las formas precoces salvo en su cronología.

Keywords: Carcinoma de recto; Dehiscencia anastomótica sintomática; Dehiscencia precoz; Dehiscencia tardía; Early anastomotic leakage; Late anastomotic leakage; Rectal cancer; Symptomatic anastomotic leakage.

PubMed Disclaimer

LinkOut - more resources