Shimomura Manabu, Yoshimitsu Masanori, Tsukada Yuichiro, Ohdan Hideki, Watanabe Jun, Fukunaga Yosuke, Hirano Yasumitsu, Sakamoto Kazuhiro, Hamamoto Hiroki, Horie Hisanaga, Matsuhashi Nobuhisa, Kuriu Yoshiaki, Nagai Shuntaro, Hamada Madoka, Yoshioka Shinichi, Ohnuma Shinobu, Hayama Tamuro, Otsuka Koki, Inoue Yusuke, Ueda Kazuki, Toiyama Yuji, Maruyama Satoshi, Yamaguchi Shigeki, Tanaka Keitaro, Suzuki Motoko, Misumi Toshihiro, Naitoh Takeshi, Watanabe Masahiko, Ito Masaaki
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan.
Department of Surgery Hiroshima City North Medical Center Asa Citizens Hospital Hiroshima Japan.
Ann Gastroenterol Surg. 2025 Jan 7;9(4):719-729. doi: 10.1002/ags3.12904. eCollection 2025 Jul.
Although extensive research has been conducted on early anastomotic leakage (AL) after sphincter-sparing surgery, the status of late anastomotic complications (post-30 days) has received limited attention. These late complications significantly affect a patient's quality of life and often lead to permanent stoma creation.
This study conducted a sub-analysis of a phase II trial assessing the outcomes of laparoscopic surgery for cStage I lower rectal adenocarcinoma (the ultimate trial). This study included 278 patients who underwent intestinal anastomosis and investigated the frequency, timing, and risk factors of late anastomotic complications (stenosis, fistula, and intestinal prolapse).
Anastomotic stenosis occurred in 27 patients (9.7%), and the median time of occurrence was 274 days (range, 70-1226 days). Only early AL ( = 0.004) was identified as an independent risk factor. A late anastomotic fistula was observed in five patients (1.8%), and 18 patients (6.4%) requiring permanent stomas. A short distance from the lower tumor margin to the anal verge (AV) ( = 0.004) and the presence of stenosis or fistula ( < 0.0001) were independent risk factors.Intestinal prolapse occurred in eight cases (3%), with a median occurrence of 221 days (range, 122-725 days). Intersphincteric resection (ISR) ( = 0.02) and splenic flexure takedown ( < 0.0001) were independent risk factors.
Anastomotic stenosis and late fistula formation frequently emerge as secondary consequences of early AL and represent significant complications linked to permanent stoma creation, often proving resistant to treatment. Intestinal prolapse is a characteristic anastomotic complication of ISR that can be caused by excessive intestinal mobilization.
尽管针对保留括约肌手术后早期吻合口漏（AL）已开展了广泛研究，但晚期吻合口并发症（术后30天之后）的情况却受到的关注有限。这些晚期并发症会显著影响患者的生活质量，且常常导致永久性造口。
本研究对一项评估I期低位直肠腺癌腹腔镜手术结局的II期试验（最终试验）进行了亚分析。本研究纳入了278例行肠吻合术的患者，并调查了晚期吻合口并发症（狭窄、瘘和肠脱垂）的发生率、发生时间及危险因素。
27例患者（9.7%）发生吻合口狭窄，中位发生时间为274天（范围70 - 1226天）。仅早期AL（P = 0.004）被确定为独立危险因素。5例患者（1.8%）出现晚期吻合口瘘，18例患者（6.4%）需要永久性造口。肿瘤下缘至肛缘（AV）距离短（P = 0.004）以及存在狭窄或瘘（P < 0.0001）为独立危险因素。8例患者（3%）发生肠脱垂，中位发生时间为221天（范围122 - 725天）。括约肌间切除术（ISR）（P = 0.02）和脾曲松解（P < 0.0001）为独立危险因素。
吻合口狭窄和晚期瘘形成常常是早期AL的继发后果，是与永久性造口相关的重要并发症，往往对治疗有抵抗性。肠脱垂是ISR特有的吻合口并发症，可由过度的肠道游离引起。
