Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2024; 16(12): 3710-3719
Published online Dec 27, 2024. doi: 10.4240/wjgs.v16.i12.3710
Onset and prognostic features of anastomotic leakage in patients undergoing radical surgery after neoadjuvant chemoradiation for rectal cancer
Lei Wang, Wang-Shan Zhang, Guo-Jin Huang
Lei Wang, Wang-Shan Zhang, Guo-Jin Huang, Department of General Surgery, The Second Hospital of Nanjing, Nanjing 210009, Jiangsu Province, China
Author contributions: Wang L and Huang GJ designed the study and performed the experiments; Wang L and Zhang WS collected the data; Huang GJ and Zhang WS analyzed the data; and Wang L and Huang GJ prepared the manuscript; All the authors have read and approved the final version of the manuscript.
Institutional review board statement: This study was approved by the ethics committee of The Second Hospital of Nanjing, No 2018-18.
Informed consent statement: Signed written informed consents were obtained from the patients and/or guardians.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request at 15951985466@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Jin Huang, MM, Doctor, Department of General Surgery, The Second Hospital of Nanjing, No. 1-1 Zhongfu Road, Gulou District, Nanjing 210009, Jiangsu Province, China. 13675188516@163.com
Received: June 5, 2024
Revised: September 23, 2024
Accepted: October 23, 2024
Published online: December 27, 2024
Processing time: 175 Days and 0.3 Hours
Abstract
BACKGROUND

Anastomotic leakage (AL) is a significant complication of rectal cancer surgery, particularly in patients undergoing neoadjuvant chemoradiotherapy. This study aimed to evaluate the onset and prognostic factors influencing AL in these patients and provide insights for better postoperative management.

AIM

To explore AL incidence in patients who underwent neoadjuvant radiotherapy for rectal cancer and evaluate influencing factors and prognosis.

METHODS

We retrospectively analyzed data of patients with rectal cancer who underwent neoadjuvant chemoradiotherapy post-radical surgery admitted to our hospital from January 2020 to January 2023. Postoperative AL was recorded in all patients. Among 63 patients with AL initially enrolled, 2 were lost to follow-up; thus, 61 patients were included in the incident group. Another 59 patients without AL were included in the non-incident group. Clinical characteristics of both groups were analyzed to identify factors affecting postoperative AL and determine prognosis.

RESULTS

Multivariate analysis revealed that sex, operative time, bleeding, pelvic radiation injury, and intraoperative blood transfusion were independent risk factors for postoperative AL (P < 0.05). The Swiss Institute for Experimental Cancer Research (ISREC) grades for patients with postoperative AL were mainly A (49.18%) and B (40.98%), and most leakages occurred in the posterior wall (65.57%). Clinical manifestations included anal sacrococaudal pain (29.51%), anal pus (26.23%), and other symptoms. Invasive interventions were performed < 2 times in 80.33% of patients. Poor prognoses were mainly associated with chronic pressacral sinus formation (24.59%), anastomotic stenosis (29.51%), and long-term stoma (19.67%). Multivariate analysis revealed distance from the anal margin and ISREC grade as independent risk factors for poor prognosis following AL (P < 0.05).

CONCLUSION

Sex, operative time, bleeding loss, pelvic radiation damage, and intraoperative blood transfusion are independent risk factors for AL and the distance between tumor and ISREC grade potentially affect prognosis.

Keywords: Neoadjuvant chemoradiotherapy; Rectal cancer; Radical surgery; Anastomotic leakage; Prognosis

Core Tip: This study identifies key risk factors and prognostic indicators for anastomotic leakage (AL) in rectal cancer patients post-neoadjuvant chemoradiotherapy and radical surgery. Independent risk factors for AL include male gender, longer operation time, significant blood loss, pelvic radiation injury, and intraoperative blood transfusion. The distance from the anal margin and the International Study Group of Rectal Cancer grade significantly affect prognosis. These findings underscore the need for careful surgical planning and management to mitigate AL risks and improve patient outcomes.