The effects of endoscopic vacuum therapy for non-operative treatment of anastomotic leakage on oncological outcomes in rectal cancer patients.

Abstract

Purpose: Rectal resection has remained the cornerstone in curative treatment of rectal cancer. This however, implies the risk of anastomotic leakage leading to morbidity, mortality and potentially disease progression. Endoscopic vacuum therapy (EVT) has emerged as a promising tool in leakage therapy in order to avoid reoperation and Hartman resection. However, its clinical efficacy and its potential effect on oncological outcomes still requires further research.

Methods: In this retrospective single-centre cohort study, we analysed all consecutive patients undergoing rectal resection for rectal cancer during 2012-2021. The incidence and management of anastomotic leakage and its effects on long-term oncological outcomes were analysed.

Results: A total of 334 patients underwent rectal resection of whom 47 patients (14.1%) developed postoperative anastomotic leakage. Non-operative leakage treatment (NOLT) was successful in in 76.9% of which EVT was the most efficient (90.0% success) while reoperation was successful in 52.4% (p = 0.073). The more frequent application of EVT increased the NOLT rate from 48.3 to 66.7% during the observation period (p = 0.176). Concerning long-term outcomes, no differences in disease-free survival (p = 0.657) nor patient survival (p = 0.295) could be determined.

Conclusion: EVT is an effective treatment option for anastomotic leakage after rectal resection. EVT enables NOLT in the majority of cases. However, there might be no impact on oncological outcomes.