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Session: ePoster: Rectal Cancer 10 (Tue8)

EP975 - Serial incidence and risk factor of anastomotic leakage after rectal cancer surgery

Tuesday, May 13, 2025
8:38 AM – 8:43 AM PT

    ePoster Presenter(s)

  • In Ja Park, MD. PhD.

    Professor
    Asan Medical Center
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • Chungyeop Lee, MD (he/him/his)

    Fellowship
    Asan Medical Center
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
In Ja Park, MD. PhD.: This individual has no financial relationships with ineligible companies.
Chungyeop Lee, M.D.: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Anastomotic leakage remains a significant complication of rectal cancer surgery, but the timing of its occurrence and associated risk factors are not well understood. This study aimed to identify risk factors for anastomotic leakage (AL) following rectal cancer surgery, based on the timing of occurrence.

Methods/Interventions: The study included patients who underwent anterior resection (AR), low anterior resection (LAR), and ultralow anterior resection (uLAR) for rectal cancer at Asan Medical Center between 2016 and 2020. Anastomotic leakage was defined as any leakage requiring intervention or reoperation and was categorized by time of occurrence: within 30 days, 31-90 days, 91 days-1 year, and more than 1 year postoperatively. Leakage occurring after 90days postoperatively was defined as late leakage.

Results/Outcomes: A total of 3,305 patients who underwent rectal cancer surgery were included in this study, with 2,120 male patients. The most common procedure was LAR (n=1,808), followed by uLAR (n=1,298), and AR (n=199). Minimally invasive techniques were employed in the majority of cases, with 1,933 laparoscopic and 817 robotic surgeries performed. Diverting stoma was created in 32.5% of cases, and preoperative chemoradiotherapy (PCRT) was administered to 28.3% of patients. Anastomotic leakage occurred in 3.5% of all cases. Leakage occurred in 4.1% of patients with a diverting stoma compared to 3.3% without a stoma. Among those who received PCRT, the leakage rate was 5.2%, significantly higher than the 3% in patients who did not receive PCRT. Regarding the timing of leakage, 47.4% occurred within 30 days, 6.8% between 31-90 days, 28.8% between 91 days and 1 year, and 17.8% after 1 year. Aging, male, and ultralow anterior resection were the risk factors of leakage. Diverting stoma and PCRT were not independent risk factors for leakage. Among patients who received PCRT, 37.8% of all leakage occurred after 1 year, identifying PCRT as a significant risk factor for delayed leakage.

Conclusion/Discussion: The study highlights that the increased use of PCRT and total neoadjuvant therapy (TNT) may raise the risk of delayed leakage. Careful consideration is required when increasing the use of PCRT and TNT, as they are important risk factors for delayed leakage.