Tailored Treatment of Anastomotic Leak After Rectal Cancer Surgery According to the Presence of a Diverting Stoma

Overview

Journal Ann Surg Treat Res

Specialty General Surgery

Date 2020 Sep 10

PMID 32908849

Citations 3

Authors

Chang Hyun Kim

Jaram Lee

Han Deok Kwak

Soo Young Lee

Jae Kyun Ju

Hyeong Rok Kim

Affiliations

Soon will be listed here.

Abstract

Purpose: A variety of clinical features of anastomotic leak occur during the surgical treatment of rectal cancer. However, little information regarding management of leakage is available and treatment guidelines have not been validated. The aim of this study was to evaluate the validity of currently proposed expert opinions on the management of anastomotic leak, after low anterior resection for rectal cancer.

Methods: A retrospective analysis was conducted for 1,786 patients who underwent sphincter-preserving surgery for rectal cancer between 2005 and 2015. Clinical outcomes including anastomotic leak-associated mortality and permanent stoma were analyzed.

Results: The overall incidence of anastomotic leak was 6.8% (122 of 1,786), including 6.1% (30 of 493 patients) with diverting stoma and 7.1% (92 of 1,293 patients) without diverting stoma (P = 0.505). A majority of patients without diversion were treated with diverting stoma (76 of 88 patients [86.4%]); 1 mortality (0.8%) was observed in this group. Treatments in the diversion group mainly included conservative treatment, local drainage, and/or transanal repair (26 of 30 patients [86.7%]). The anastomotic failure rates were 20.7% (19 of 92 patients) in the no diversion group and 53.3% (16 of 30 patients) in the diversion group. In the multivariate analysis, preoperative chemoradiotherapy (P < 0.001) and delayed diagnosis of anastomotic leak (P = 0.036) were independent risk factors for permanent stoma.

Conclusion: Management of anastomotic leak should be tailored to individual patients. When anastomotic leak occurred, preoperative chemoradiotherapy and delayed diagnosis seemed to be associated with permanent stoma.

Citing Articles

Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer.

Momose H, Takahashi M, Kawai M, Sugimoto K, Takahashi H, Motegi S J Anus Rectum Colon. 2025; 9(1):88-94.

PMID: 39882218 PMC: 11772786. DOI: 10.23922/jarc.2024-047.

Reconstruction, oversewing, or taking the anastomosis down - which surgical intervention is most potent in the treatment of anastomotic leaks following colorectal resections?.

El-Ahmar M, Koch F, Ristig M, Lehmann K, Ritz J Langenbecks Arch Surg. 2023; 408(1):266.

PMID: 37405509 DOI: 10.1007/s00423-023-02986-2.

Does temporary ileostomy via specimen extraction site affect the short outcomes and complications after laparoscopic low anterior resection in rectal cancer patients? A propensity score matching analysis.

Peng D, Yu D, Liu X, Tao W, Kang B, Zhang H BMC Surg. 2022; 22(1):263.

PMID: 35799152 PMC: 9264509. DOI: 10.1186/s12893-022-01715-8.

Diverting ileostomy itself may not increase the rate of postoperative readmission related to dehydration after low anterior resection.

Park S, Kim M, Lee D, Park S, Han K, Hong C Ann Surg Treat Res. 2021; 101(2):111-119.

PMID: 34386460 PMC: 8331557. DOI: 10.4174/astr.2021.101.2.111.

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