Time interval between rectal cancer resection and reintervention for anastomotic leakage and the impact of a defunctioning stoma: A Dutch population‐based study

Colorectal Disease, vol. 23, pp. 2937–2947

Abstract

AIM: In the Netherlands, a selective policy of faecal diversion after rectal cancer surgery is generally applied. This study aimed to evaluate the timing, type, and short-term outcomes of reoperation for anastomotic leakage after primary rectal cancer resection stratified for a defunctioning stoma. METHOD: Data of all patients who underwent primary rectal cancer surgery with primary anastomosis from 2013-2019 were extracted from the Dutch ColoRectal Audit. Primary outcomes were new stoma construction, mortality, ICU admission, prolonged hospital stay, and readmission. RESULTS: In total, 10,772 rectal cancer patients who underwent surgery with primary anastomosis were included, of whom 46.6% received a primary defunctioning stoma. The reintervention rate for anastomotic leakage was 8.2% and 11.6% for patients with and without a defunctioning stoma (p < 0.001). Reintervention consisted of reoperation in 44.0% and 85.3% (p < 0.001), with a median time interval from primary resection to reoperation of seven days (IQR 4-14) vs. five days (IQR 3-13), respectively. In the presence of a defunctioning stoma, early reoperation (<5 days; n = 47) was associated with significantly more end-colostomy construction (51% vs. 33%) and ICU admission (66% vs. 38%) than late reoperation (≥5 days; n = 127). Without defunctioning stoma, early reoperation (n = 252) was associated with significantly higher mortality (4% vs. 1%), and more ICU admissions (52% vs.34%) than late reoperation (n = 302). CONCLUSIONS: Early reoperations after rectal cancer resection are associated with worse outcomes reflected by a more frequent ICU admission in general, more colostomy construction, and higher mortality in patients with primary defunctioned and nondefunctioned anastomosis.

Authors 4

1. Anne‐Loes K. Warps Aachen Department of Surgery Leiden University Medical Centre Leiden University Leiden The Netherlands Dutch Institute for Clinical Auditing Leiden The Netherlands

   Leiden University · Leiden University Medical Center · Dutch Institute for Clinical Auditing

   Affiliation as printed

   Department of Surgery Leiden University Medical Centre Leiden University Leiden The Netherlands

   Dutch Institute for Clinical Auditing Leiden The Netherlands

2. Rob A.�E.�M. Tollenaar Aachen Department of Surgery Leiden University Medical Centre Leiden University Leiden The Netherlands Dutch Institute for Clinical Auditing Leiden The Netherlands

   Leiden University · Leiden University Medical Center · Dutch Institute for Clinical Auditing

   Affiliation as printed

   Department of Surgery Leiden University Medical Centre Leiden University Leiden The Netherlands

   Dutch Institute for Clinical Auditing Leiden The Netherlands

3. Pieter Job Tanis

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Surgery Amsterdam University Medical Centres Cancer Centre Amsterdam University of Amsterdam Amsterdam The Netherlands

4. Jan Willem T. Dekker corresponding

   Reinier de Graaf Hospital

   Affiliation as printed

   Department of surgery Reinier de Graaf Groep Delft The Netherlands