Late anastomotic leakage after low anterior resection in rectal cancer patients: clinical characteristics and predisposing factors

Abstract

Late anastomotic leakages that develop after 30 days following low anterior resection are not uncommon and may be associated with the use of radiotherapy. Late leakage should be a different entity from early leakage in terms of the type of leakage, methods of management and subsequent sequelae.

Very Early Colorectal Anastomotic Leakage within 5 Post-operative Days: a More Severe Subtype Needs Relaparatomy

“…reported that early symptomatic AL (diagnosed during initial hospital stay, average 8 post-operative days) performed worse than late AL (diagnosed after discharge, average 22 post-operative days) with regard to oral intake, bowel activity and initial hospital stay. Early AL within 30 days after surgery was associated with increased proportions of patients needing relaparatomy (78.8–89% vs 44–55.4%)1213. Several factors may contribute to this discrepancy.…”

“…Early anastomotic leakage, defined as AL occurring within 30 post-operative days1216, represents a unique entity requiring more aggressive intervention1213 and causing elevated motality rate compared with late AL. However, since majorities of AL occurred 5–10 days after surgery, cut-point of 30 post-operative days makes late AL rarity17 accounting for less than 4 percent of AL cases as indicated by a Korean team reporting 290 AL from 10477 colorectal carcinomas1.…”

“…Generally, early AL is associated with severe general peritonitis responsible for emergency relaparatomy and increased motality rate910. By contrast, late AL is associated with long lasting pelvic abscess11121314. Definition of late AL is generally regarded as leakage occurred one month after surgery121315 or patient’s discharge16 from majorities of literature.…”

“…By contrast, late AL is associated with long lasting pelvic abscess11121314. Definition of late AL is generally regarded as leakage occurred one month after surgery121315 or patient’s discharge16 from majorities of literature. This cut-point time makes late AL a rare event17 accounting for less than 4% as indicated by a Korean team reporting 290 AL from 10477 colorectal carcinomas1.…”

Late leakage after anterior resection: a defunctioning stoma alters the clinical course of anastomotic leakage

“…Characteristics of late leakage (LL) are examined in a few studies without a uniform definition of LL, where the cutoff point is suggested as diagnosis postoperative day (POD) > 21, POD > 30 or after hospital discharge [16][17][18][19][20][21][22][23]. LL incidence varies from 1.3% to 7.7% representing 30-40% of all AL cases [16,19]. The POD to diagnosis of LL ranges from 22 to 99 days, mainly reflecting the discrepancies in LL definition [19][20][21][22].…”