Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study.
OBJECTIVE
Anastomotic leakage (AL) after total mesorectal excision (TME) for rectal cancer is suspected to alter function. However, very few reports have been devoted to this problem. The aim of this study was to assess the influence of AL on function and quality of life (QoL) after laparoscopic TME for cancer.


METHODS
A total of 170 patients who underwent laparoscopic TME and sphincter-saving surgery for mid and low rectal cancer were included (67 % after neoadjuvant chemoradiotherapy). Twenty-one patients with AL were assessed for function and QoL (Short Form 36 (SF-36), Fecal Incontinence Quality of Life (FIQL), CR-29, and Wexner's score) at the most recent follow-up. These patients were matched to 42 patients without AL according to sex, body mass index, ypTNM, radiotherapy, and type of anastomosis.


RESULTS
After a median follow-up of 30 months, AL significantly impaired physical activity (SF-36) (p = 0.004), self-respect (FIQL) (p = 0.029), wear pad's score (Wexner's score) (p = 0.043), and blood and mucus in stool score (CR-29) (p = 0.001). Overall Wexner's score did not show any significant difference in the two groups, 8.9 in AL patients vs. 11.6 in patients without AL (p = 0.1).


CONCLUSIONS
AL significantly impairs both functional results and quality of life after laparoscopic sphincter-saving TME for rectal cancer. However, the observed difference was only limited, leading to similar outcomes on most of the tested scores. Patients with AL should be warned that if they initially experience severely impaired results, outcomes tend with time to become similar to those observed in noncomplicated patients.
Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Denis Diderot (Paris VII), 100 boulevard du Général Leclerc, 92110, Clichy, France.
Cécile
C
Mongin
Léon
L
Maggiori
Julie
J
Agostini
Marianne
M
Ferron
Yves
Y
Panis
D000230:Adenocarcinoma / Q000601:surgery* / Q000628:therapy; D000368:Aged; D001003:Anal Canal; D057868:Anastomotic Leak / Q000503:physiopathology* / Q000523:psychology*; D059248:Chemoradiotherapy / Q000009:adverse effects; D003672:Defecation; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D012007:Rectum / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome