Patient factors may predict anastomotic complications after rectal cancer surgery

Abstract

PurposeAnastomotic complications following rectal cancer surgery occur with varying frequency. Preoperative radiation, BMI, and low anastomoses have been implicated as predictors in previous studies, but their definitive role is still under review. The objective of our study was to identify patient and operative factors that may be predictive of anastomotic complications.MethodsA retrospective review was performed on patients who had sphincter-preservation surgery performed for rectal cancer at a tertiary medical center between 2005 and 2011.Results123 patients were included in this study, mean age was 59 (26–86), 58% were male. There were 33 complications in 32 patients (27%). Stenosis was the most frequent complication (24 of 33). 11 patients required mechanical dilatation, and 4 had operative revision of the anastomosis. Leak or pelvic abscess were present in 9 patients (7.3%); 4 were explored, 2 were drained and 3 were managed conservatively. 4 patients had permanent colostomy created due to anastomotic complications. Laparoscopy approach, BMI, age, smoking and tumor distance from anal verge were not significantly associated with anastomotic complications. After a multivariate analysis chemoradiation was significantly associated with overall anastomotic complications (Wall = 0.35, p = 0.05), and hemoglobin levels were associated with anastomotic leak (Wald = 4.09, p = 0.04).ConclusionOur study identifies preoperative anemia as possible risk factor for anastomotic leak and neoadjuvant chemoradiation may lead to increased risk of complications overall. Further prospective studies will help to elucidate these findings as well as identify amenable factors that may decrease risk of anastomotic complications after rectal cancer surgery.

Low Incidence of Pelvic Sepsis after Hartmann’s Procedure: Radiation Therapy May Be a Risk Factor

“…There are conflicting findings in the literature whether neoadjuvant RT in rectal cancer has been related to anastomotic leakage [8, 9]. In the present study, neoadjuvant RT was a risk factor for developing pelvic sepsis, and this would be logical if the pathophysiology was similar, namely RT causing inflammation and edema, leading to relative ischemia.…”

Short‐term outcomes after surgical resection for colorectal cancer in South Australia

“…Higher risk of anastomotic leak and major complications has been reported for more distal sites, for example, rectal versus colonic . Proximity to other organs and increased likelihood of neo‐adjuvant therapy may be contributing factors among rectal patients . Greater risk of complications among men may be due to the anatomical differences, for example, narrower pelvic width, leading to increased technical difficulty during surgery .…”

“…Proximity to other organs and increased likelihood of neo‐adjuvant therapy may be contributing factors among rectal patients . Greater risk of complications among men may be due to the anatomical differences, for example, narrower pelvic width, leading to increased technical difficulty during surgery . Lower risk of complications among the privately insured and those in the mid‐high SES category may be due to better overall health status and lifestyle factors.…”

“…to increased technical difficulty during surgery [29]. Lower risk of complications among the privately insured and those in the midhigh SES category may be due to better overall health status and lifestyle factors.…”

The Effect of TISSEEL® on Colorectal Anastomosis Healing Process in a Diabetic Animal Experimental Model

“…Peripheral angiopathy is another factor that is frequently encountered in diabetic patients which per se results in impairment of the integrity of colorectal anastomoses (15). Diabetes affects a large number of physiological factors involved in the healing process, such as growth factor production, angiogenic response, collagen concentration, tissue granulation and extracellular matrix accumulation and remodeling by matrix metalloproteinases (16). However, fibrin sealants have been used as hemostatic factors and enhancers of the wound healing process in various surgical procedures including gastrointestinal anastomoses, plastic surgery, gynecologic and urologic procedures (17,18).…”