Late anastomotic leakage after rectal cancer surgery common, milder than early leakage

Late anastomotic leakage (AL) is more common than AL in rectal cancer patients who undergo surgery after neoadjuvant chemoradiotherapy (nCRT) and is less likely to involve require intensive intervention, a recent study has found.

Researchers conducted a retrospective review of 85 patients who had undergone elective rectal cancer surgery. AL occurring within ≤30 days of the surgery was deemed early-onset, while cases occurring afterward were defined as late AL. Clinical, pathological, and inflammatory parameters were compared between patients who had late vs early AL.

Overall, 16 and eight patients developed late and early AL, respectively, while the remaining 61 had no AL. In the respective AL groups, leakage was diagnosed after an average of 7.5±3.2 and 244.7±265.7 days. Early AL patients also required more aggressive intervention than late AL counterparts (p=0.001).

Moreover, early AL was associated with greater inflammation at the time of leakage diagnosis, with higher white blood cell counts, neutrophil-to-lymphocyte ratio, and levels of C-reactive protein (p<0.001). One patient with early AL died, while no deaths were reported in the late AL group.

Multivariate analysis was performed to identify potential predictors of late AL and revealed that the presence of inflammation around anastomosis, as detected by cardiac tomography, was the only factor independently and significantly correlated with late AL (odds ratio, 61.9, 95 percent confidence interval, 3.64–1,052.34; p=0.004).

“Late AL showed a much higher incidence than early AL among patients who underwent advanced rectal cancer surgery after nCRT as a standard treatment. Late AL with mild inflammatory status was treated with gentle intervention and was more frequently asymptomatic at the time of diagnosis compared with early AL,” the researchers said.