Incidence and Risk Factors of Surgical Complications and Anastomotic Leakage After Transanal Total Mesorectal Excision for Middle and Low Rectal Cancer

• Published in: Journal of gastrointestinal surgery 2023-02, Vol.27 (2), p.373-381
• Main Authors: Xu, Fengming, Li, Haoze, Guo, Ce, Yang, Zhengyang, Gao, Jiale, Zhang, Xiao, Wei, Qi, Meng, Cong, Sun, Liting, Wu, Guocong, Yao, Hongwei, Zhang, Zhongtao
• Format: Article
• Language: English
• Subjects: Abdomen; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Anastomotic Leak - surgery; Asymptomatic; Classification; Colorectal cancer; Contraindications; Gastroenterology; Gastrointestinal surgery; Hospitals; Humans; Incidence; Intestinal obstruction; Laparoscopy; Laparoscopy - methods; Medical imaging; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Original Article; Ostomy; Patient satisfaction; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Postoperative period; Prospective Studies; Quality of life; Rectal Neoplasms - surgery; Rectum - surgery; Retrospective Studies; Risk Factors; Surgery; Surgical outcomes; Transanal Endoscopic Surgery - methods
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-022-05546-z

Purpose Transanal total mesorectal excision (taTME) is a promising surgical procedure for middle and low rectal cancer; however, it is linked to significant morbidity. This study aimed to determine the incidence of postoperative surgical complications and anastomotic leakage following taTME and to identify their associated risk factors. Methods The prospective clinical data of 114 patients, who underwent taTME and primary anastomosis for mid-low rectal cancer between November 2016 and June 2022, were retrospectively analyzed. Univariate and multivariate analyses were performed to identify clinical characteristics and risk factors for predicting surgical complications and anastomotic leakage. Results Surgical complications occurred in 40 (35.1%) patients within the first 30 days following surgery. Based on the Clavien–Dindo classification, minor complications (Clavien–Dindo grades I + II) accounted for 30.7%, while major complications (Clavien–Dindo grades III + IV) accounted for only 4.4%. None of the patients died within 30 days. The incidence of anastomotic leakage was 15.8%: 4.4% as grade A (5 cases), 9.6% as grade B (11 cases), and 1.8% as grade C (2 cases). Preoperative T3-4 was identified as an independent risk factor for surgical complications ( p  = 0.031) by multivariate analysis. American Society of Anesthesiology score ≥ 3 ( P  = 0.021) and incomplete total mesorectal excision specimens ( P  = 0.030) were significantly associated with the risk of anastomotic leakage. Conclusions In this study, the incidence of surgical complications and anastomotic leakage in taTME aligned with previously reported rates. Preoperative T3-4 was significantly associated with surgical complications. American Society of Anesthesiology score ≥ 3 and incomplete TME specimens independently increased the risk of anastomotic leakage.