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. 2022 Aug;37(8):1807-1816.
doi: 10.1007/s00384-022-04213-8. Epub 2022 Jul 12.

Long-term outcome after chronic anastomotic leakage following surgery for low rectal cancer

Florian Ponholzer  1 , Clemens Paul Klingler  1 , Elisabeth Gasser  1 , Philipp Gehwolf  1 , Marijana Ninkovic  1 , Ruben Bellotti  1 , Reinhold Kafka-Ritsch  1 , Dietmar Öfner  2
Affiliations

Long-term outcome after chronic anastomotic leakage following surgery for low rectal cancer

Florian Ponholzer et al. Int J Colorectal Dis. 2022 Aug.

Abstract

Purpose: This study analyzed the prevalence and factors influencing the history of chronic anastomotic leakage following low anterior resection for rectal cancer. Furthermore, the treatment of a persisting presacral sinus and the impact of stoma reversal on outcome were evaluated.

Methods: The institutional database was scanned for all patients with anastomotic leakage, who were primarily treated for low rectal cancer between January 1995 and December 2019. Patients with rectovaginal and rectovesical fistula or an inadequate follow-up were excluded (n = 5). After applying the exclusion criteria, 71 patients remained for analysis.

Results: A total of 39 patients out of 71 patients with anastomotic leakage (54.9%) developed a persisting presacral sinus. Neoadjuvant radiochemotherapy or chemotherapy showed a significant impact on the formation of a chronic anastomotic leakage (radiochemotherapy: p = 0.034; chemotherapy: p = 0.050), while initial surgical treatment showed no difference for anastomotic healing (p = 0.502), but a significantly better overall survival (p = 0.042). Multiple therapies and surgical revision had a negative impact on patients' rate of natural bowel continuity (p = 0.006/ < 0.001). In addition, the stoma reversal cohort showed improved overall 10-year survival (p = 0.004) and functional results (bowel continuity: p = 0.026; pain: p = 0.031).

Conclusion: Primary surgical therapy for chronic anastomotic leakage should consist of surgical treatment. Furthermore, the reversal of a protective stoma should be considered a viable option in treating chronic presacral sinus to improve pain symptoms and bowel continuity.

Keywords: Bowel continuity; Chronic anastomotic leakage; Chronic presacral sinus; Low rectal cancer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection for statistical analysis
Fig. 2
Fig. 2
Comparison of the rate of post-therapeutic pain symptoms between subgroups
Fig. 3
Fig. 3
Ten-year survival with confidence intervals stratified by treatment modality
Fig. 4
Fig. 4
Ten-year survival with confidence intervals stratified by stoma reversal decision
See this image and copyright information in PMC

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