On long-term outcome of anastomotic leakage after anterior resection for rectal cancer

Sammanfattning: Background: Anterior resection has the benefit of enabling bowel continuity, but suffer from a common complication in anastomotic leakage.There is a paucity in previous research of long-term implications of anastomotic leakage after anterior resection.Aims: To gain general knowledge of the morbidity related to anastomotic leakage after anterior resection for rectal cancer, specific aims were:I.To investigate late detected anastomotic leakage after anterior resection regarding incidence, and evaluate its clinical features and clinical variables associated to late detected anastomotic leakage.II.To evaluate how often bowel continuity is restored in long-term follow-up after anastomotic leakage in anterior resection and clinical factors related to a permanent stoma.III.To explore rectal contrast studies of patients with anastomotic leakage for predicitve features related to an outcome of permanent stoma.IV.To evaluate the effect of anastomotic leakage after anterior resection on long-term bowel dysfunctionV.To evaluate the effect of anastomotic leakage after anterior resection on Quality of Life, as well as to evaluate the effect of maintained bowel continuity in anastomotic leakage patients on Quality of Life.Methods: Paper I-III, a retrospective cohort of patients subjected to anterior resection in the Southern healthcare region of Sweden was used to identify patients with anastomotic leakage according to a study protocol definition. This group of anastomotic leakage patients was investigated with respect to late leakage, permanent stoma in long-term follow-up and radiological features associated with an outcome of permanent stoma. In paper IV and V a retrospective cohort of patients subjected to anterior resection in the Southern, Western and Northern healthcare regions of Sweden 2007-2013 was used, the effect of anastomotic leakage on bowel dysfunction and Quality of Life was investigated using propensity score matching models.Results and conclusions: Anastomotic leakage after anterior resection is associated with signifcant long-term morbidity. Late detected anastomotic leakage after anterior resection is common and related to use of a defunctioning stoma at anterior resection. Two-thirds of all patients with anastomotic leakage after anterior resection end up with a permanent stoma in long-term follow-up, wheras in patients with bowel continuity there is a doubled risk of severe bowel dysfunction. However, no superiority in Quality of Life related to outcome in bowel continuity could be demonstrated.