Risk Factors in Anastomotic Leaks After Low Anterior Resection for Rectal Cancer and the Effects of Diverting Stoma on Clinical Results

Abstract

Aim: The aim of this study was to determine the risk factors which might render patients who underwent rectal cancer surgery prone to anastomotic leaks (AL) and to investigate whether diverting stoma (DS) alleviated the severity of AL. Method: Patients who underwent elective curative surgery because of rectal cancer in our clinic between January 2010 and December 2016 were included in the study. The definition and grading of AL were ascertained by utilizing the criteria put forward by The International Study Group of Rectal Cancer (ISREC). The relationships among the variables related to clinical, surgical, and pathological results of patients observed to have clinical AL were investigated through univariate and multivariate analyses. Those patients observed to have AL were classified into two groups as those with and without DS opening within the framework of the subgroup analysis. Results: Of 110 patients who underwent low anterior resection, AL was detected in 19 patients (17.2%). Sixty-three patients (57.3%) had DS during the first surgery [DS (+)], while 47 patients (42.7%) did not [DS (-)]. The results of the univariate analysis revealed significant associations between AL and male sex, chronic artery disease (CAD), preoperative chemoradiation (CRT), preoperative hemoglobin 300 (minute). There was no significant relationship between AL and DS [p=0.653; odds ratio (OR)=0.797; 95% confidence interval (CI)=0.295-2.149]. The results of the multivariate analysis, however, showed CAD (p=0.024; OR=4.201; 95% CI=0.069-0.824) and preoperative CRT (p=0.030; OR=3.66; 95% CI=0.017-1.804) as independent prognostic factors. In subgroup analysis of patients with AL, the DS (-) group had significantly longer mean hospital stay (p=0.049), higher Clavien-Dindo morbidity score (p=0.028), and more severe AL (p=0.002). Relaparotomy was performed in 7 patients (77.7%) in the DS (-) group but none of the patients in the DS (+) group (p=0.001). Conclusion: CAD and preoperative CRT were seen to be related to the increased risk of anastomotic leaks after rectal cancer surgery. We believe that diversion ostomy procedures alleviate the severity of anastomotic leaks although they fail to decrease anastomotic leak and postoperative mortality rates. Moreover, we are of the opinion that they enable the palliative treatment of leaks in this way and lessen the need for emergency reoperations.

Keywords

• Low anterior resection
• anastomotic leak
• rectal cancer