Trends in the management and success rate of anastomotic leakage after rectal surgery: Outcome improvements using a proactive diagnosis and treatment strategy at two academic centers - 10/12/25
, Jérémie H. Lefevre aHighlights |
• | Management of anastomotic leakage has changed over time with an effort in standardization of diagnosis and treatment strategies. |
• | Relevant diagnostic (modern use of CRP dosage and CT-scan at diagnosis) and therapeutic changes in the management (more invasive strategy with transanal drainage) of AL after rectal cancer surgery were noted, and our success rate (i.e., the preservation of a functional anastomosis) has significantly improved. |
• | The interest of a faster, more intensive, proactive strategy to AL should be further evaluated in a prospective controlled trial. |
Summary |
Purpose |
Management of anastomotic leakage (AL) following rectal surgery is not standardized. The aim was to evaluate the trends of clinical practice management and outcome of AL over time.
Method |
All patients with grade B symptomatic AL after rectal surgery from January 2012 to January 2022 in two centers were included. Diagnostic and treatment management was compared in 3 time periods: 2012–2014, 2015–2018 and 2019–2021. Success was defined as a completely healed, preserved and functional anastomosis. Univariate and multivariate analyses were used to identify predictive factors of success.
Results |
In total, 194 patients with symptomatic AL were included. The overall success rate was 57%. The use of CRP dosage and CT scan for diagnosis increased overtime from 44% and 81% in 2012–2014, 75% and 95% in 2015–2018, 69% and 100% in 2019–2021, respectively. The use of anal examination under general anesthesia also increased over time: 48% in 2012–2014, 35% in 2015–2018, 60% in 2019–2021 ( P = 0.025). Success rate increased significantly: 51% in 2012–2014, 52% in 2015–2018, 77% in 2019–2021 ( P = 0.026). In multivariate analysis, absence of preoperative radiotherapy (OR = 2.137, IC95%(1.08–4.22), P = 0.029) and most recent period of care (OR = 0.319, IC95%(0.12–0.82), P = 0.017) were independent factors associated to the healing of AL.
Conclusion |
Across time, relevant diagnostic and therapeutic changes are observed in the management of AL after rectal cancer surgery, translating in improved outcomes with a higher rate of anastomotic preservation.
Le texte complet de cet article est disponible en PDF.Keywords : Anastomotic leakage, Colorectal anastomosis, Coloanal anastomosis, Anal examination, Percutaneous drainage
Plan
Vol 162 - N° 6
P. 416-423 - décembre 2025 Retour au numéro
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