Onset and prognostic features of anastomotic leakage in patients undergoing radical surgery after neoadjuvant chemoradiation for rectal cancer.

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.