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BMC Cancer
Published in: BMC Cancer 1/2020

01-12-2020 | Rectal Cancer | Research article

Long term outcome of anastomotic leakage in patients undergoing low anterior resection for rectal cancer

Authors: Alice Artus, Nicolas Tabchouri, Othman Iskander, Nicolas Michot, Olivier Muller, Urs Giger-Pabst, Pascal Bourlier, Céline Bourbao-Tournois, Aurore Kraemer-Bucur, Thierry Lecomte, Ephrem Salamé, Mehdi Ouaissi

Published in: BMC Cancer | Issue 1/2020

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Abstract

Background

The influence of anastomotic leakage (AL) on local recurrence rates and survival in rectal cancer remains controversial. The aim of this study was to analyze the effect of asymptomatic anastomotic leakage (AAL) and symptomatic anastomotic leakage (SAL) on short- and long-term outcome after curative rectal cancer resection.

Methods

All patients who underwent surgical resection of non-metastatic rectal cancer with curative intent from January 2005 to December 2017 were retrospectively analyzed. Short-term morbidity, long-term functional and oncological outcomes were compared between patients with SAL, AAL and without AL (WAL).

Results

Overall, 200 patients were included and AL was observed in 39 (19.5%) patients (10 AAL and 29 SAL) with a median follow-up of 38.5 months. Rectal cancer location and preoperative neoadjuvant treatment was similar between the three groups. Postoperative 30-day mortality rate was nil. The permanent stoma rate was higher in patients with SAL or AAL compared to WAL patients (44.8 and 30% vs 9.3%, p < 0.001). The mean wexner continence grading scale was significantly different between AAL (11,4 ± 3,8), SAL (10,3 ± 0,6) and WAL (6,4 ± 4,7) groups (p = 0.049). The 3 and 5-year overall and disease-free survival rates were similar between the 3 groups (86.6% /84% vs 100%/100% vs 76%/70 and 82.9%/77% vs 100%/100% vs 94.7%/88.3% for patients with SAL, AAL, and WAL, p = 0.480 and p = 0.527).

Conclusion

The permanent stoma rate was significant higher in patients with SAL or AAL compared to WAL patients. AL did not impair long-term oncological outcome.
Literature
1.
Heald RJ, Husband EM, Ryall RDH. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg. 1982;69:613–6.PubMed
2.
Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345:638–46.PubMed
3.
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.PubMed
4.
Bosset J-F, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006;355:1114–23.PubMed
5.
Martling A, Holm T, Rutqvist LE, Johansson H, Moran BJ, Heald RJ, et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm. Br J Surg. 2005;92:225–9.PubMed
6.
Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005;241:465–9.PubMedPubMedCentral
7.
Kanso F, Maggiori L, Debove C, Chau A, Ferron M, Panis Y. Perineal or abdominal approach first during Intersphincteric resection for low rectal Cancer: which is the best strategy? Dis Colon Rectum. 2015;58:637–44.PubMed
8.
Matthiessen P, Hallböök O, Rutegard J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207.PubMedPubMedCentral
9.
Yeh CY, Changchien CR, Wang J-Y, Chen J-S, Chen HH, Chiang J-M, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg. 2005;241:9.PubMedPubMedCentral
10.
Peeters KCMJ, Tollenaar RAEM, Marijnen CAM, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92:211–6.PubMed
11.
Hain E, Manceau G, Maggiori L, Mongin C, la Prost À DJ, Panis Y. Bowel dysfunction after anastomotic leakage in laparoscopic sphincter-saving operative intervention for rectal cancer: A case-matched study in 46 patients using the Low Anterior Resection Score. Surgery. 2017;161:1028–39.PubMed
12.
Maggiori L, Bretagnol F, Lefèvre JH, Ferron M, Vicaut E, Panis Y. Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer: conservative management is associated with a decreased risk of definitive stoma. Color Dis. 2011;13:632–7.
13.
Holmgren K, Kverneng Hultberg D, Haapamäki MM, Matthiessen P, Rutegård J, Rutegård M. High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study. Color Dis. 2017;19:1067–75.
14.
Mak JCK, Foo DCC, Wei R, Law WL. Sphincter-preserving surgery for low rectal cancers: incidence and risk factors for permanent stoma. World J Surg. 2017;41:2912–22.PubMed
15.
Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W. Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal Cancer: a systematic review and meta-analysis. World J Surg. 2017;41:277–84.PubMed
16.
Hain E, Maggiori L, Manceau G, Mongin C, la Prost À DJ, Panis Y. Oncological impact of anastomotic leakage after laparoscopic mesorectal excision. Br J Surg. 2017;104:288–95.PubMed
17.
Espín E, Ciga MA, Pera M, Ortiz H. The Spanish rectal Cancer project. Oncological outcome following anastomotic leak in rectal surgery. Br J Surg. 2015;102:416–22.PubMed
18.
Hain E, Maggiori L, Manceau G, Zappa M, la Prost À DJ, Panis Y. Persistent Asymptomatic Anastomotic Leakage After Laparoscopic Sphincter-Saving Surgery for Rectal Cancer: Can Diverting Stoma Be Reversed Safely at 6 Months? Dis Colon Rectum. 2016;59:369–76.PubMed
19.
Lefevre JH, Rousseau A, Svrcek M, Parc Y, Simon T, Tiret E. A multicentric randomized controlled trial on the impact of lengthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design. BMC Cancer. 2013;13:417.PubMedPubMedCentral
20.
21.
Glimelius B, Tiret E, Cervantes A, Arnold D, on behalf of the ESMO Guidelines Working Group. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(suppl 6):vi81–8.PubMed
22.
Bretagnol F, Panis Y, Rullier E, Rouanet P, Berdah S, Dousset B, et al. Rectal cancer surgery with or without bowel preparation: the French GRECCAR III multicenter single-blinded randomized trial. Ann Surg. 2010;252:863–8.PubMed
23.
Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum. 2017;60:761–84.PubMed
24.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the international study Group of Rectal Cancer. Surgery. 2010;147:339–51.PubMed
25.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedPubMedCentral
26.
Washington MK, Berlin J, Branton P, Burgart LJ, Carter DK, Fitzgibbons PL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. Arch Pathol Laboratory Med. 2009;133:1539–51.
27.
Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255:922–8.PubMed
28.
Vaizey CJ, Kamm MA, Turner IC, Nicholls RJ, Woloszko J. Effects of short term sacral nerve stimulation on anal and rectal function in patients with anal incontinence. Gut. 1999;44:407–12.PubMedPubMedCentral
29.
Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impotence Res. 1999;11:319.
30.
Jenkinson C, Coulter A, Wright L. Short form 36 (SF36) health survey questionnaire: normative data for adults of working age. BMJ. 1993;306:1437–40.PubMedPubMedCentral
31.
32.
Brooks R, Group E. EuroQol: the current state of play. Health policy. 1996;37:53–72.PubMed
33.
Rullier E, Zerbib F, Marrel A, Amouretti M, Lehur P-A. Validation of the French version of the fecal incontinence quality-of-life (FIQL) scale. Gastroenterol Clin Biol. 2004;28:562–8.PubMed
34.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147:573–7.
35.
Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.PubMed
36.
den Dulk M, Marijnen CAM, Collette L, Putter H, Påhlman L, Folkesson J, et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg. 2009;96:1066–75.
37.
McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102:462–79.PubMed
38.
Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Color Dis. 2004;6:462–9.
39.
Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–8.PubMed
40.
Lim M, Akhtar S, Sasapu K, Harris K, Burke D, Sagar P, et al. Clinical and subclinical leaks after low colorectal anastomosis: a clinical and radiologic study. Dis Colon Rectum. 2006;49:1611–9.PubMed
41.
Breukink SO, van der Zaag-Loonen HJ, Bouma EMC, Pierie JPEN, Hoff C, Wiggers T, et al. Prospective evaluation of quality of life and sexual functioning after laparoscopic total mesorectal excision. Dis Colon Rectum. 2007;50:147–55.PubMed
42.
Bloemen JG, Visschers RGJ, Truin W, Beets GL, Konsten JLM. Long-term quality of life in patients with rectal cancer: association with severe postoperative complications and presence of a stoma. Dis Colon Rectum. 2009;52:1251–8.PubMed
43.
Hoerske C, Weber K, Goehl J, Hohenberger W, Merkel S. Long-term outcomes and quality of life after rectal carcinoma surgery. Br J Surg. 2010;97:1295–303.PubMed
44.
Ashburn JH, Stocchi L, Kiran RP, Dietz DW, Remzi FH. Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life. Dis Colon Rectum. 2013;56:275–80.PubMed
45.
Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2001;88:400–4.PubMed
Metadata
Title
Long term outcome of anastomotic leakage in patients undergoing low anterior resection for rectal cancer
Authors
Alice Artus
Nicolas Tabchouri
Othman Iskander
Nicolas Michot
Olivier Muller
Urs Giger-Pabst
Pascal Bourlier
Céline Bourbao-Tournois
Aurore Kraemer-Bucur
Thierry Lecomte
Ephrem Salamé
Mehdi Ouaissi
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2020
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-020-07109-4

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