Factors associated with leakage after reversal of protective stoma in patients with locally advanced rectal cancer following curative resection and anastomosis.

Abstract

Introduction: Anastomotic leakage (AL) is a significant complication in colorectal surgery with numerous general and specific risk factors. The determinants of colorectal AL following the reversal of a protective defunctioning ileostomy remain unclear and warrant further investigation.

Material and methods: Data from April 2008 to December 2014 were collected and retrospectively reviewed for 361 consecutive patients who underwent protective ileostomy reversal following curative resection with anastomosis for rectal cancer. The baseline, treatment, and oncological variables of patients associated with post-reversal AL were evaluated using univariate and multivariate logistic regression analysis. The impact of AL on long-term survival outcomes was assessed using Kaplan-Meier survival analyses.

Results: In a study of 361 patients, 52 (14.4 %) experienced leakage following stoma reversal, manifesting at a median of 5.7 months. Multivariable logistic regression analysis revealed that an anastomosis located less than 7 cm from the anal verge (OR 2.82, p = 0.008), a side-to-end anastomotic configuration (OR 2.02, p = 0.036), involvement of the circumferential resection margin (OR 6.46, p = 0.043), and adjuvant radiotherapy (OR 4.69, p = 0.003) significantly predicted post-reversal AL. Notably, five-year overall survival (63.4 % vs. 90.3 %, p < 0.0001) and disease-free survival (46.9 % vs. 71.1 %, p = 0.001) were significantly lower in patients with post-reversal AL.

Conclusions: Our analysis identified several clinicopathological factors associated with post-reversal AL, which is linked to a significant decrease in long-term survival and oncological outcomes. Alleviating these adverse effects necessitates ensuring early detection and effective management of leaks among high-risk patients.