Delayed anastomotic leakage following laparoscopic intersphincteric resection for lower rectal cancer: report of four cases and literature review

Masayoshi Iwamoto,Yoshiharu Sakai,Kenji Kawada,Koya Hida,Suguru Hasegawa

doi:10.1186/s12957-017-1208-2

Abstract

BackgroundAnastomotic leakage (AL) is one of the most dreadful postoperative complications because it can result in increased morbidity and mortality as well as poorer long-term prognosis. Although most studies of AL limited their investigation time to a period of 30 days postoperatively, only a few studies have shown that AL can occur after that period. Here, we report four patients of rectal cancer with delayed AL following laparoscopic intersphincteric resection (ISR) and conduct a literature review on delayed AL.Case presentationCase 1 was a 67-year-old male who underwent laparoscopic partial ISR in July 2009. Although the patient was asymptomatic, an anastomotic-urethral fistula was observed 57 months after ISR. Case 2 was a 44-year-old female who underwent laparoscopic partial ISR in July 2008. She presented with discharge of gas and feces from her vagina, and an anastomotic-vaginal fistula was observed 14 months after ISR. Case 3 was a 74-year-old man who underwent laparoscopic partial ISR in August 2007. He presented with pneumaturia and fecaluria, and an anastomotic-urethral fistula was observed 4 months after ISR. Case 4 was a 68-year-old woman who underwent laparoscopic subtotal ISR for rectal cancer in February 2013 and partial hepatic resection for liver metastases in March 2013. She presented with anal pain and purulent perineal discharge, and an anastomotic-perineal fistula was observed 9 months after ISR. All four cases presented with fistula formation and required reoperation (establishment of a diverting ileostomy).ConclusionsSince delayed AL is not a rare postoperative complication, surgeons need to provide long-term follow-up and remain alert to the possible development of delayed AL.

Highlights

Anastomotic leakage (AL) is one of the most dreadful postoperative complications of colorectal cancer because it can result in increased morbidity and mortality as well as poorer long-term prognosis
The gold standard of surgical technique for rectal cancer is total mesorectal excision (TME), which results in improved survival and reduced local recurrence
June 2015 suggested that a total of 41 rectal cancer patients underwent laparoscopic intersphincteric resection (ISR) at our institution and that the incidence rate of delayed AL was 9.8% (4/41), whereas that of early AL was 0% (0/41)

Summary

Background

The introduction of intersphincteric resection (ISR) is one of the recent advances in the surgical treatment of lower rectal cancer. A 67-year-old male who was diagnosed with lower rectal cancer underwent laparoscopic partial ISR with creation of a diverting ileostomy in July 2009. She was diagnosed with internal hemorrhoids, and she was treated using an aluminum potassium sulfate and tannic acid (ALTA) injection Her anal bleeding continued and she was admitted to our hospital because lower rectal cancer was detected by colonoscopy. She underwent laparoscopic partial ISR with creation of a diverting ileostomy in July 2008, and the pathological analysis indicated that the tumor staging was stage I (pT2N0M0). She underwent laparoscopic subtotal ISR for rectal cancer, and ,

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