The impact of anastomotic level and preventive ileostomy on postoperative anastomotic fistula in rectal cancer patients

Abstract

Objective To evaluatate the impact of different anastomotic location and preventive ileostomy on postoperative anastomotic fistula in rectal cancer patients. Methods The clinical data of 316 cases of rectal cancer patients after total mesorectal excision from January 2015 to January 2016 were analyzed retrospectively. Patients were divided into anterior resection (AR) group, low anterior resection(LAR)group, ultra-low anterior resection(ULAR)group according to the anastomotic location. There were 33 cases of anastomotic fistula with preventive ileostomy or without and anastomotic leakage varied from mild to severe as grade A, B, C. Results There was no statistically significant difference in the incidence of anastomotic fistula between the different anastomotic location (χ2=3.829, P=0.147). In anterior resection group and low anterior resection group , there was no statistically significant difference in the incidence of anastomotic fistula whether or not a preventive ileostomy was performed (χ2=0.606, 1.096, P=0.436, 0.326). While in ultralow anterior resection group, preventive ileostomy helped dicrease the incidence of anastomotic fistula (χ2=11.667, P=0.001), and once happened the severity of the anastomotic fistula tended to be less severe. Conclusion The incidence of anastomotic fistula does not vary with anastomotic level in our study. Preventive ileostomy reduces the incidence of anastomotic fistula in patients with ultralow anterior resection. Key words: Rectal neoplasms; Anastomotic leak; Preventive ileostomy