Minor impact of anastomotic leakage on long-term quality of life after anterior resection: a population-based cohort study

Introduction Anastomotic leakage (AL) following anterior resection (AR) for rectal cancer impacts morbidity and bowel dysfunction. The aim of this study was to evaluate the impact of leakage on health-related quality of life (HRQoL) three years after surgery, as the evidence regarding long-term effects is limited. Method This population-based observational study included patients who underwent AR in Sweden between 2015 and 2017, retrieved from the Swedish Colorectal Cancer Registry. The main outcome measure was the summary score of EORTC QLQ–C30, a validated questionnaire developed to assess the quality of life of cancer patients, three years after surgery; secondary outcomes were from the colorectal-cancer specific EORTC QLQ–CR29. Targeted maximum likelihood estimation was used to assess the influence of leakage on HRQoL, accounting for confounders. Result Of 1,778 eligible patients, 1,178 (66.3%) responded, including 104 (8.8%) with AL. Patients with leakage reported a significantly lower summary score, considered a small difference (80 vs. 86, p < 0.001); this effect was estimated at -4 (p = 0.002) after adjustment. These patients also had worse body image, more sore skin around the anus and more leakage of stool from the stoma bag (if present), considered medium differences. Discussion AL following AR seems to have a minor negative impact on HRQoL three years postoperatively, while these patients have a worse reported body image, sore skin around the anus and leakage of stool from the stoma bag. These findings highlight the importance of patient counselling and long-term follow-up for patients with AL.