Long-term functional results and quality of life after redo rectal surgery: delayed versus immediate colo-anal anastomosis.

Abstract

To compare the functional results and quality of life after delayed colo-anal anastomosis (DCAA) or immediate colo-anal anastomosis (ICAA) following redo rectal surgery. Twenty-six patients with DCAA between 2014 and 2018 were studied retrospectively (group A). Two control groups were used: 26 ICAA after redo surgery (group B) and 52 colo-anal anastomosis (CAA) after anterior resection (group C). Control groups were matched for age, sex, pelvic radiotherapy and time to surgery. Low Anterior Resection Syndrome (LARS) and Gastrointestinal Quality of Life Index (GIQLI) scores were used to assess function and quality of life. The indications for surgery were comparable for groups A and B: anastomotic failure with chronic sepsis (38% vs 50%, P=0.40), vaginal fistula (42% vs 42%, P=1) and urinary fistula (20% vs 8%, P=0.22) as well as the number of previous abdominal operations (1.3±0.9 vs 1.1±0.6, P=0.19). The median LARS score in the first 2years was 30 [interquartile range (IQR) 14-41] for group A, 23 (IQR 0-41) for group B and 22 (IQR 11-37) for group C. After 2years, the median LARS score improved in each group [A, 21 (IQR 11-35); B, 18 (IQR 5-26); C, 13 (IQR 9-20)], but was still high in group A. There was a tendency toward more major LARS in group A than in group B (46% vs 27%; P=0.149). There was no difference in the mean GIQLI score between groups A and B (120±16 vs 117±19; P=0.53) at the end of the follow-up period. Time after stoma closure (<2years) and previous radiotherapy were risk factors for major LARS in all populations. ICAA should be the procedure of choice where possible in redo surgery as it has better functional outcomes.