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High 1-Year Complication Rate after Anterior Resection for Rectal Cancer

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Surgical options after anterior resection for rectal cancer include a primary anastomosis, anastomosis with a defunctioning stoma, and an end colostomy. This study describes short-term and 1-year outcomes of these different surgical strategies.

Methods

Patients undergoing surgical resection for primary mid and high rectal cancer were retrospectively studied in seven Dutch hospitals with 1-year follow-up. Short-term endpoints were postoperative complications, re-interventions, prolonged hospital stay, and mortality. One-year endpoints were unplanned readmissions and re-interventions, presence of stoma, and mortality.

Results

Nineteen percent of 388 included patients received a primary anastomosis, 55 % an anastomosis with defunctioning stoma, and 27 % an end colostomy. Short-term anastomotic leakage was 10 % in patients with a primary anastomosis vs. 7 % with a defunctioning stoma (P = 0.46). An end colostomy was associated with less severe re-interventions. One-year outcomes showed low morbidity and mortality rates in patients with an anastomosis. Patients with a defunctioning stoma had high (18 %) readmissions and re-intervention (12 %) rates, mostly due to anastomotic leakage. An end colostomy was associated with unplanned re-interventions due to stoma/abscess problems. During follow-up, there was a 30 % increase in patients with an end colostomy.

Conclusions

This study showed a high 1-year morbidity rate after anterior resection for rectal cancer. A defunctioning stoma was associated with a high risk for late complications including anastomotic leakage. An end colostomy is a safe alternative to prevent anastomotic leakage, but stomal problems cannot be ignored. Selecting low-risk patients for an anastomosis may lead to favorable short- and 1-year outcomes.

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Authors and Affiliations

  1. Department of Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300, RC, Leiden, The Netherlands

    H. S. Snijders & R. A. E. M. Tollenaar

  2. Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands

    I. S. Bakker, K. Havenga & T. Wiggers

  3. Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands

    J. W. T. Dekker

  4. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands

    T. A. Vermeer

  5. Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands

    E. C. J. Consten

  6. Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands

    C. Hoff

  7. Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands

    J. M. Klaase

Authors
  1. H. S. Snijders
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  2. I. S. Bakker
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  6. C. Hoff
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  7. J. M. Klaase
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  8. K. Havenga
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  9. R. A. E. M. Tollenaar
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  10. T. Wiggers
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Correspondence to H. S. Snijders.

Additional information

Snijders HS and Bakker IS equally contributed to this manuscript.

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Snijders, H.S., Bakker, I.S., Dekker, J.W.T. et al. High 1-Year Complication Rate after Anterior Resection for Rectal Cancer. J Gastrointest Surg 18, 831–838 (2014). https://doi.org/10.1007/s11605-013-2381-4

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  • DOI: https://doi.org/10.1007/s11605-013-2381-4

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