Abstract
BackgroundAnastomotic leakage can be classified by free and contained leakage according to clinical manifestations. The risk factors and their comparison between these leakage subtypes are uncertain. This study aims to evaluate anastomotic leakage patterns and to compare clinical features between free and contained leakages after low anterior resection for rectal cancer.Materials and methodsBetween January 2005 and December 2012, a total of 2035 consecutive patients who underwent low anterior resection for primary rectal cancer were evaluated retrospectively at two-tertiary referral centers. The primary end points of this study were to assess detailed clinical features among leakage subtypes. The secondary end point was to compare risk factors between free and contained leakages.ResultsPatients were subdivided into a no leakage group (n = 1890), free leakage group (n = 73), and contained leakage group (n = 72). Free leakage occurred more frequently in laparoscopic and robotic surgeries than open surgery (p = 0.015). On the other hand, contained leakage was developed in a higher rate of patients who received preoperative chemoradiotherapy (p<0.001). The mean development time was 4.6 days in the free leakage group, and 23.6 days in the contained leakage group. Patients with free leakage had a lower rate of a defunctioning stoma than contained leakage (5.5% vs. 29.2%, p<0.001). Risk factors for free leakage were smoking, tumor location, and laparoscopic surgery. However, tumor location and preoperative chemoradiotherapy increased the risk for contained leakage.ConclusionsContained leakage in rectal cancer surgery showed different clinical manifestations and risk factors compared to free leakage. It is necessary to pay more attention to patients with particular risk factors for anastomotic leakage subtypes.
Highlights
Anastomotic leakage is one of the most lethal complications after colorectal surgery
Patients with free leakage had a lower rate of a defunctioning stoma than contained leakage (5.5% vs. 29.2%, p
Contained leakage in rectal cancer surgery showed different clinical manifestations and risk factors compared to free leakage
Summary
Anastomotic leakage is one of the most lethal complications after colorectal surgery. Anastomotic leakage has been defined using different standards such as clinical symptoms, development time, grade of surgical intervention, and severity of anastomotic disruption. Floodeen et al compared early and late symptomatic anastomotic leakage after low anterior resection according to the time of diagnosis.[6] In contrast, in 2010, the International Study Group of Rectal Cancer proposed a definition of anastomotic leakage based on severity grading for surgical intervention.[5] other studies described free and contained leakages. Anastomotic leakage can be classified by free and contained leakage according to clinical manifestations. This study aims to evaluate anastomotic leakage patterns and to compare clinical features between free and contained leakages after low anterior resection for rectal cancer
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