Long-term outcome after chronic anastomotic leakage following surgery for low rectal cancer

• Published in: International journal of colorectal disease Vol. 37; no. 8; pp. 1807 - 1816
• Main Authors: Ponholzer, Florian, Klingler, Clemens Paul, Gasser, Elisabeth, Gehwolf, Philipp, Ninkovic, Marijana, Bellotti, Ruben, Kafka-Ritsch, Reinhold, Öfner, Dietmar
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2022; Springer; Springer Nature B.V
• Subjects: Analysis; Anastomotic leak; Cancer; Cancer therapies; Care and treatment; Chemoradiotherapy; Chemotherapy; Colorectal cancer; Gastroenterology; Hepatology; Internal Medicine; Intestine; Medicine; Medicine & Public Health; Ostomy; Pain; Patients; Proctology; Rectum; Sinuses; Surgery; Survival; Chronic anastomotic leakage; Chronic presacral sinus; Bowel continuity; Low rectal cancer
• ISSN: 1432-1262; 0179-1958; 1432-1262
• DOI: 10.1007/s00384-022-04213-8

Purpose
This study analyzed the prevalence and factors influencing the history of chronic anastomotic leakage following low anterior resection for rectal cancer. Furthermore, the treatment of a persisting presacral sinus and the impact of stoma reversal on outcome were evaluated.
Methods
The institutional database was scanned for all patients with anastomotic leakage, who were primarily treated for low rectal cancer between January 1995 and December 2019. Patients with rectovaginal and rectovesical fistula or an inadequate follow-up were excluded (
n
 = 5). After applying the exclusion criteria, 71 patients remained for analysis.
Results
A total of 39 patients out of 71 patients with anastomotic leakage (
54.9%
) developed a persisting presacral sinus. Neoadjuvant radiochemotherapy or chemotherapy showed a significant impact on the formation of a chronic anastomotic leakage (radiochemotherapy:
p
 = 0.034; chemotherapy:
p
 = 0.050), while initial surgical treatment showed no difference for anastomotic healing (
p
 = 0.502), but a significantly better overall survival (
p
 = 0.042). Multiple therapies and surgical revision had a negative impact on patients’ rate of natural bowel continuity (
p
 = 0.006/ < 0.001). In addition, the stoma reversal cohort showed improved overall 10-year survival (
p
 = 0.004) and functional results (bowel continuity:
p
 = 0.026; pain: 
p
 = 0.031).
Conclusion
Primary surgical therapy for chronic anastomotic leakage should consist of surgical treatment. Furthermore, the reversal of a protective stoma should be considered a viable option in treating chronic presacral sinus to improve pain symptoms and bowel continuity.