The Impact of Anastomotic Leakage on Long-Term Function after Anterior Resection for Rectal Cancer

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Kverneng Hultberg, DanielUmeå University,Umeå universitet,Kirurgi (author)

The Impact of Anastomotic Leakage on Long-Term Function after Anterior Resection for Rectal Cancer

Article/chapterEnglish2020

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American Society of Colon & Rectal Surgeons,2020
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LIBRIS-ID:oai:DiVA.org:umu-166884
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-166884URI
https://doi.org/10.1097/DCR.0000000000001613DOI
https://lup.lub.lu.se/record/15dfd14e-1e18-42fa-9505-7e68047ec380URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Previously included in thesis in manuscript form.
Background: It is still not clear whether anastomotic leakage after anterior resection for rectal cancer affects long-term functional outcome.Objective: To evaluate how anastomotic leakage following anterior resection for rectal cancer influences defecatory, urinary and sexual function.Design: In this retrospective population-based cohort study, patients were identified through the Swedish Colorectal Cancer Registry, which was also used for information on the exposure variable anastomotic leakage, and covariates.Settings: A nationwide register was used for including patients.Patients: All patients undergoing anterior resection for rectal cancer in Sweden from April 2011– June 2013 were included.Main Outcome Measures: Outcome was any defecatory, sexual or urinary dysfunction, assessed two years after surgery by a postal questionnaire. The association between anastomotic leakage and function was assessed in multivariable logistic and linear regression models, with adjustment for confounding.Results: Response rate was 82%, resulting in 1180 included patients. Anastomotic leakage occurred in 7.5%. A permanent stoma was more common among leak patients (44% vs. 9%; p<0.001). Leakage patients had an increased risk of aid use for fecal incontinence (OR 2.27; 95% CI 1.20-4.30) and reduced sexual activity (90% vs. 82%; p=0.003), while the risk of urinary incontinence was decreased (OR 0.53; 95% CI 0.31-0.90). A sensitivity analysis assuming that a permanent stoma was created due to anorectal dysfunction strengthened the negative impact of leakage on defecatory dysfunction.Limitations: Limitations include the used questionnaire not having been previously validated, underreporting of anastomotic leakage in the register, and small patient numbers in the analysis of sexual symptoms.Conclusions:a Anastomotic leakage was found to statistically significantly increase the risk of aid use due to fecal incontinence and reduced sexual activity, though the impact on defecatory dysfunction might be underestimated, as permanent stomas are sometimes fashioned due to anorectal dysfunction. Further research is warranted, especially regarding urogenital function.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kirurgi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Surgery hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cancer and Oncology hsv//eng
Anastomotic dehiscence
postoperative complications
incontinence
sexual function
dysfunction
anastomotic leakage
anorectalfunction
Surgery
kirurgi
Anastomotic dehiscence
Anastomotic leakage
Anorectal function
Dysfunction
Incontinence
Postoperative complications
Sexual function

Added entries (persons, corporate bodies, meetings, titles ...)

Svensson, Johan,1978-Umeå University,Umeå universitet,Statistik,Kirurgi(Swepub:umu)josv0027 (author)
Jutesten, HenrikLund University,Lunds universitet,Kirurgi,Forskargrupper vid Lunds universitet,Surgery,Lund University Research Groups,Skåne University Hospital(Swepub:lu)he0484ju (author)
Rutegård, Jörgen,1948-Umeå University,Umeå universitet,Kirurgi(Swepub:umu)jaru0001 (author)
Matthiessen, PeterÖrebro University (author)
Lydrup, Marie LouiseLund University,Lunds universitet,Kirurgi,Forskargrupper vid Lunds universitet,Surgery,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-msl (author)
Rutegård, Martin,1982-Umeå University,Umeå universitet,Kirurgi,Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM)(Swepub:umu)maru0039 (author)
Umeå universitetKirurgi (creator_code:org_t)

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In:Diseases of the Colon & Rectum: American Society of Colon & Rectal Surgeons63:5, s. 619-6280012-37061530-0358

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