Minimal long-term impact of anastomotic leakage on quality of life after anterior resection for rectal cancer: A population-based cohort study.

Abstract

Background: Anastomotic leakage after anterior resection for rectal cancer is associated with long-term morbidity, such as bowel dysfunction, but its impact on health-related quality of life remains insufficiently studied. The aim of this study was to evaluate the association between anastomotic leakage and health-related quality of life 3 years after surgery.

Methods: In this population-based prospective cohort study, patients who underwent anterior resection for rectal cancer in Sweden between 2015 and 2017 were identified through the Swedish Colorectal Cancer Registry. Health-related quality of life was assessed 3 years after surgery using the EORTC QLQ-C30 and QLQ-CR29 questionnaires. The primary outcome was the QLQ-C30 summary score. Targeted maximum likelihood estimation was applied to estimate the adjusted effect of anastomotic leakage on health-related quality of life.

Results: Of 1778 eligible patients, 1178 (66.3%) responded, including 104 (8.8%) with anastomotic leakage. Patients with anastomotic leakage reported a lower mean QLQ-C30 summary score compared to those without anastomotic leakage (80 vs 86, p < 0.001). After adjustment for confounders, anastomotic leakage was associated with a 4-point difference in summary score (p < 0.01). Patients with anastomotic leakage also reported worse body image. Compared with patients without anastomotic leakage, those with anastomotic leakage and no stoma reported more perianal skin irritation, while those with a stoma more frequently reported stool leakage from the stoma bag.

Conclusions: Anastomotic leakage after anterior resection is associated with a small negative effect on overall health-related quality of life 3 years after surgery. Nevertheless, specific functional impairments-particularly related to body image, and stoma- or perianal symptoms-persist and warrant attention. These findings highlight the importance of patient counseling and long-term follow-up after anastomotic leakage.