Neoadjuvant radiotherapy and anastomosis dehiscence after total mesorectal excision for stage II and III rectal cancer

Summary Background Anterior resection is nowadays the preferred option of surgical treatment for rectal cancer without sphincter involvement. However, this operation is associated with the risk of anastomosis dehiscence (AD). Aim The aim of this study was to estimate the influence of neoadjuvant radiotherapy and other factors on the risk of anastomosis dehiscence after total mesorectal excision for stage II and III rectal cancer. Materials/Methods One hundred and thirty consecutive patients operated on due to histologically confirmed rectal carcinoma were studied with prospective data collection. Elective surgery with curative intent was administered. All patients underwent sphincter-sparing anterior resection with total mesorectal excision. End-to-end anastomosis with double stapled technique was performed. Impact of patient-, tumour- and treatment-related variables on anastomosis dehiscence rate was evaluated in univariate and multivariate analysis. Results Incidence of AD was 10.6%. There was no leakage-related mortality. Univariate analysis showed that patient's age and gender, presence of lymph node metastases and irradiation setting (pre- vs post-operative) did not significantly influence dehiscence rate (P>0.05). Tumour level at or below 7cm from the anal verge was related to increased AD risk with statistical importance (P=0.0438). Neither pelvic drainage nor omentoplasty effectively protected the anastomosis. Proximal diversion with protective stoma resulted in significantly decreasing AD risk (P=0.0012). In multivariate analysis the presence of transversostomy was found as the most important factor independently associated with significantly lower incidence of AD. Conclusions Neoadjuvant radiotherapy does not seem to be a significant risk factor for anastomosis dehiscence, even after resection of low-sited tumours, but proximal diversion with temporary stoma needs to be considered.