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Anastomotic leakage in relation to type of mesorectal excision and defunctioning stoma use in anterior resection for rectal cancer
Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.ORCID iD: 0000-0002-0974-6373
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0002-8601-0159
Department of Molecular Medicine and Surgery, Karolinska Institutet, Department of Surgery, Ersta Hospital, Stockholm, Sweden.
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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2024 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 67, no 3, p. 398-405Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Anastomotic leakage after anterior resection for rectal cancer is more common after total mesorectal excision compared to partial mesorectal excision but might be mitigated by a defunctioning stoma.

OBJECTIVE: The aim is to assess how anastomotic leakage is affected by type of mesorectal excision and defunctioning stoma use.

DESIGN: This is a retrospective multicenter cohort study evaluating anastomotic leakage after anterior resection. Multivariable Cox regression with HRs and 95% CIs was used to contrast mesorectal excision types and defunctioning stoma use with respect to anastomotic leakage, with adjustment for confounding.

SETTINGS: This multicenter study included patients from 11 Swedish hospitals between 2014 and 2018.

PATIENTS: Patients who underwent anterior resection for rectal cancer were included.

MAIN OUTCOMES MEASURES: Anastomotic leakage rates within and after 30 days of surgery are described up to 1 year after surgery.

RESULTS: Anastomotic leakage occurred in 24.2% and 9.0% of 1126 patients operated with total and partial mesorectal excision, respectively. Partial compared to total mesorectal excision was associated with a reduction in leakage, with an adjusted HR of 0.46 (95% CI, 0.29-0.74). Early leak rates within 30 days were 14.9% with and 12.5% without a stoma, whereas late leak rates after 30 days were 7.5% with and 1.9% without a stoma. After adjustment, defunctioning stoma was associated with a lower early leak rate (HR 0.47; 95% CI, 0.28-0.77). However, the late leak rate was nonsignificantly higher in patients with defunctioning stomas (HR 1.69; 95% CI, 0.59-4.85).

LIMITATIONS: This study was limited by its retrospective observational study design.

CONCLUSIONS: Anastomotic leakage is common up to 1 year after anterior resection for rectal cancer, where partial mesorectal excision is associated with a lower leak rate. Defunctioning stomas seem to decrease the occurrence of leakage, although partially by only delaying the diagnosis. See Video Abstract.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024. Vol. 67, no 3, p. 398-405
Keywords [en]
Anterior resection, Leak, Mesorectal excision, Rectal, Stoma
National Category
Surgery
Identifiers
URN: urn:nbn:se:umu:diva-222965DOI: 10.1097/DCR.0000000000003050ISI: 001169589200009PubMedID: 37994449Scopus ID: 2-s2.0-85184657029OAI: oai:DiVA.org:umu-222965DiVA, id: diva2:1850949
Funder
Knut and Alice Wallenberg Foundation, RV-762241Swedish Society of Medicine, SLS-934594Cancerforskningsfonden i Norrland, AMP 19-978Bengt Ihres Foundation, SLS-934603Swedish Cancer Society, CAN 2018/589Available from: 2024-04-11 Created: 2024-04-11 Last updated: 2024-04-11Bibliographically approved

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Rutegård, MartinSvensson, Johan

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Wallenberg Centre for Molecular Medicine at Umeå University (WCMM)SurgeryStatistics
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