Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea.
Int J Colorectal Dis. 2020 Jul;35(7):1321-1330. doi: 10.1007/s00384-020-03608-9. Epub 2020 May 5.
Although multiple studies have examined anastomotic leakage (AL) after low anterior resection (LAR), their definitions of AL varied, and few have studied late diagnosed AL after surgery. This study aimed to characterize late AL after anal sphincter saving surgery (SSS) for rectal cancer by examining clinical characteristics, risk factors, and management of patients with late AL compared with early AL.
Data from January 2005 to December 2014 were collected from a total of 1903 consecutive patients who underwent anal sphincter saving surgery for rectal cancer and were retrospectively reviewed. Late AL was defined as AL diagnosed more than 30 days after surgery. Variables and risk factors associated with early and late diagnosed AL were analyzed by multivariate logistic regression.
Overall, early, and late rates of AL were 13.7%, 6.7%, and 7%, respectively. Receiving neoadjuvant chemoradiotherapy (nCRT) was a risk factor for developing late AL, but not early AL (OR, 3.032; 95% CI, 1.947-4.722; p < 0.001). Protective ileostomy did not protect against late AL. Among the 134 patients with late AL, 26 (19.4%) were classified as asymptomatic and 108 patients (80.6%) as symptomatic. The most frequent symptomatic complications related to late AL were fistula (42 cases, 39.7%), chronic sinus (33 cases, 31.1%), and stenosis (31 cases, 29.2%).
Clinical characteristics, risk factors, and management of patients with late AL after SSS were different from early AL. Close attention should be given to consider late AL as the continuation of early AL.
尽管多项研究已经探讨了低位前切除术（LAR）后吻合口漏（AL）的问题，但它们对 AL 的定义各不相同，而且很少有研究关注手术后迟发性 AL。本研究旨在通过检查临床特征、风险因素以及与早期 AL 相比，接受保肛手术治疗直肠癌的患者中迟发性 AL 的管理，来描述保肛手术后的迟发性 AL。
本研究回顾性分析了 2005 年 1 月至 2014 年 12 月期间共 1903 例接受保肛手术治疗直肠癌的患者的数据。迟发性 AL 定义为手术后 30 天以上确诊的 AL。通过多变量逻辑回归分析，对与早期和晚期确诊的 AL 相关的变量和风险因素进行分析。
总体而言，早期和晚期 AL 的发生率分别为 13.7%、6.7%和 7%。接受新辅助放化疗（nCRT）是发生迟发性 AL 的危险因素，但不是早期 AL 的危险因素（OR，3.032；95% CI，1.947-4.722；p<0.001）。预防性回肠造口术并不能预防迟发性 AL。在 134 例迟发性 AL 患者中，26 例（19.4%）为无症状患者，108 例（80.6%）为有症状患者。与迟发性 AL 最相关的症状性并发症包括瘘（42 例，39.7%）、慢性窦道（33 例，31.1%）和狭窄（31 例，29.2%）。
SSS 后迟发性 AL 的临床特征、风险因素和管理与早期 AL 不同。应密切关注迟发性 AL，将其视为早期 AL 的延续。
