Anastomotic leakage does not increase rectal cancer recurrence risk

By Sarah Guy, medwireNews Reporter

Incidence of clinical anastomotic leak after anterior resection for patients with rectal adenocarcinoma does not increase the risk for local disease recurrence (LR), despite previous studies indicating the opposite, report US researchers.

Their results also show that a defunctioning stoma is associated with lower incidence of clinical leakage after surgery, but that cancer outcomes including LR, disease-free survival, and overall survival remained the same regardless of stoma status.

However, rates of anastomotic complications such as clinical leaks and late rectovaginal fistula were similar in patients with stoma and those without, indicating that defunctioning stomas "do not prevent anastomotic disturbances, but rather reduce their clinical impact," say the authors in the Annals of Surgery.

"We suspect that centers with appropriate rectal cancer volume, technical expertise, and careful patient selection can achieve a low incidence of both anastomotic leak and LR. In this setting, anastomotic complications do not appear to significantly impact oncologic outcomes," suggest Garrett Nash (Memorial Sloan-Kettering Cancer Center, New York) and co-investigators.

The team examined rates of clinical leak - defined as an anastomotic event requiring intervention or interventional radiology within 60 days of surgery - in 1127 patients treated with total or tumor-specific mesorectal excision between 1991 and 2010, and followed up for a median 6.2 years.

Five-year rates of LR were low overall, at 5%, and disease-specific and overall survival were high, at 90% and 87%, respectively. Indeed, after controlling for factors including distance of tumor from the anal verge, presence of stoma, clinical leak, and stage of disease, only tumor stage (stage 2 and 3 versus 1) had an effect on these oncological outcomes.

The overall anastomotic leak and complication rates were lower in patients with a defunctioning stoma than in those without, at a respective 2.2% and 9.3% versus 5.3% and 11.8%, but these differences were not significant.

Authors of previous studies have suggested that all patients should have a defunctioning stoma to reduce the need for reoperation, however; they did not analyze the morbidity associated with the operation to close the stoma, remark Nash et al.

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