Analysis of Risk Factors and Management of Anastomotic Leakage After Rectal Cancer Surgery: An Indian Series

Abstract

The primary objective of this study was to determine whether sphincter preservation is possible among patients who develop anastomotic leakage after rectal cancer surgery. The secondary objective was to determine the factors that may contribute to anastomotic leakage. This is a retrospective review of a prospectively maintained database. All patients with rectal cancer who underwent restorative proctectomy over 1 year were included in the study. The parameters analyzed were age, preoperative hemoglobin and albumin, neoadjuvant therapy, type of surgery, level of ligation of inferior mesenteric pedicle, technique of anastomosis, and defunctioning proximal stoma. In this study, 176 cases of anterior resection were included,of which15 (8.5 %) had anastomotic leakage. None of the factors contributing to anastomotic leakage reached statistical significance on univariate analysis. Among the patients who had proximal defunctioning ileostomy (n = 9), five (56 %) required re-surgery whereas other four were managed with antibiotics and presacral drainage alone (44 %). Among the patients who didnot have proximal defunctioning ileostomy (n = 6), all (100 %) required re-surgery. Among the 12 eligible patients, stoma reversal was successful in eight (67 %) patients. This study highlights the importance of defunctioning proximal stoma in reducing the incidence and severity of anastomotic leakage as well as the need and extent of re-surgery for low rectal cancer. Sphincter preservation is possible in majority of patients who develop anastomotic leakage after rectal cancer surgery.

Laparoscopic versus open resection in locally advanced rectal cancers: a propensity matched analysis of oncological and short‐term outcomes

“…Higher anastomotic leak rates and a higher number of exenterative surgeries in the open arm might have offset the results favouring the laparoscopy arm in the present cohort as far as overall morbidity is concerned. One of our previous studies had also noted higher anastomotic leak rates in open surgery [29].…”

A Novel Nomogram for Prediction of Early Postoperative Complications of Total Gastrectomy for Gastric Cancer

“…[4][5][6][7][8] Complications adversely affect patients' health condition and is associated with high morbidity and mortality rates. [9][10][11][12] The etiology of complications, especially the complications related to the anastomosis, is multifactorial and generally believed to be sex, age, surgical situation and the general condition of the patient. 13 Careful management of postoperative complications in total gastrectomy is necessary.…”

Prediction model for anastomotic leakage after laparoscopic rectal cancer resection

“…AL adversely affects patients' health condition and is associated with high morbidity and mortality rates, negatively impacting patient's oncological, clinical, and functional outcomes. [1][2][3][4][5] It is associated with a perioperative mortality rate ranging from 6.12% to 10.00%. 5 AL leads to immediate clinical consequences such as intraabdominal or pelvic abscesses, peritonitis, sepsis, increased in-hospital morbidity and mortality, a prolonged hospital stay, the need for systemic antibiotics, the need for reintervention, and increased overall costs.…”

“…[1][2][3][4][5] It is associated with a perioperative mortality rate ranging from 6.12% to 10.00%. 5 AL leads to immediate clinical consequences such as intraabdominal or pelvic abscesses, peritonitis, sepsis, increased in-hospital morbidity and mortality, a prolonged hospital stay, the need for systemic antibiotics, the need for reintervention, and increased overall costs. It also has long-term adverse effects including impaired pelvic organ or anorectal function, increased local cancer recurrence and cancer-specific mortality rates, decreased long-term survival, and a poor prognosis.…”