Clinical analysis of anastomotic dehiscence after low anterior resection for rectal cancer

Objectives To analyze retrospectively the clinico-pathological features influencing the occurrence of anastomotic leakage after low anterior resection of rectal cancer, as well as its management and outcome of patients. Methods The clinico-pathological features of 674 cases of low-situated rectal cancer were analyzed retrospectively. The relationship between the occurrence of anastomotic leakage and the patients' gender, tumor size, tumor location, Dukes' staging, emergency or elective operation and techniques of anastomosis was evaluated. The clinical manifestations of the anastomotic leakage and its management were also reviewed. Results Anastomotic leakage occurred in 39(5.8%) cases, with a 95% confidence interval (CI) of 4.02%-7.54%. The incidence of anastomotic leakage in patients with tumor within or greater than 6 cm from the anus was 6.2% and 5.5% respectively. The incidence of anastomotic leakage in patients with tumor larger or less than 3 cm in diameter was 5.9% and 5.5% respectively. The incidence of anastomotic leakage in patients with Dukes' B, C and D stage was 2.4%, 7.9% and 7.4% respectively. The emergency operation led to a higher rate of anastomotic leakage compared to that of the elective operation (26.7% vs 5.3%). Conclusions The occurrence rate of anastomotic leakage is not correlated to the size (P=0.962) and location (P=0.798) of the carcinoma; however, it is closely related to the type of operation (P=0.003) and the Dukes staging (P=0.018). The major clinical manifestations of the anastomotic leakage include intermittent or persistent fever, paralytic ileus and discharge of faecal material in the drainage tube. Local irrigation via the drainage tube, total parenteral nutrition and construction of defunctioning stoma are the main strategic points to manage the leakage.