Risk Factors for and Oncologic Impact of Anastomotic Leakage After Sphincter-Preserving Proctectomy for Mid/Low Rectal Cancer: A Multi-institutional Cohort Study in Japan
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View abstract on PubMed
Summary
This summary is machine-generated.Diverting ostomy is recommended after sphincter-preserving proctectomy for rectal cancer, as its absence increases anastomotic leakage risk, particularly in males. Anastomotic leakage also elevates local recurrence risk in stage III disease.
Area Of Science
- Colorectal Surgery
- Surgical Oncology
- Gastroenterology
Background
- Anastomotic leakage is a significant complication following sphincter-preserving proctectomy for rectal cancer.
- The role of diverting ostomy in preventing leakage and its impact on long-term oncologic outcomes remain unclear.
Purpose Of The Study
- To investigate the association between diverting ostomy and anastomotic leakage.
- To evaluate the influence of anastomotic leakage on oncologic outcomes in rectal cancer patients.
Main Methods
- Retrospective analysis of a multicenter database (69 institutions) of patients with stage II-III mid/low rectal cancer.
- Patients underwent sphincter-preserving proctectomy between January 2010 and December 2011.
- Factors associated with anastomotic leakage and its oncologic impact were assessed.
Main Results
- Anastomotic leakage occurred in 13.6% of 922 patients, correlating with higher reoperation rates, longer hospital stays, and increased permanent ostomy rates.
- Absence of diverting ostomy (OR 2.46) and male sex (OR 2.54) were independent risk factors for anastomotic leakage.
- Anastomotic leakage increased local recurrence risk in stage III disease (HR 2.11) but did not affect overall or recurrence-free survival.
Conclusions
- Absence of diverting ostomy and male sex are significant risk factors for anastomotic leakage after sphincter-preserving proctectomy.
- Anastomotic leakage is linked to increased local recurrence in stage III rectal cancer.
- Findings support the use of protective diversion in select rectal cancer patients undergoing sphincter-preserving proctectomy.
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