Type of anastomosis in rectal cancer surgery is not associated with anastomotic leakage and impaired bowel function at long-term follow-up

BACKGROUND AND OBJECTIVE: The optimal type of anastomosis for preventing anastomotic leakage (AL) and bowel dysfunction after colorectal surgery remains uncertain. The aim of the study was to evaluate anastomotic type after anterior resection (AR) in relation to AL and functional outcome in long-term follow-up. METHODS: This was a population-based study using data from the Swedish Colorectal Cancer Registry (SCRCR). The patients were categorized into two groups, based on anastomotic design ("J-pouch/side-to-end (STE) anastomosis" or "end-to-end (ETE) anastomosis"). AL was established using SCRCR and supplemented with review of medical records. The low anterior resection syndrome (LARS) score questionnaire and Cleveland Clinic Florida Fecal Incontinence score (CCFFIS) were used for the assessment of bowel function. The associations and the predefined confounders were adjusted for using logistic regression/linear mixed-effects models. RESULTS: A total of 710 patients who underwent curative rectal cancer surgery with AR between 2007 and 2013 were included. AL occurred in 87 (15.7%) patients in the STE group and 10 (10.2%) in the ETE group. After adjustment, the type of anastomosis (STE versus ETE) did not affect the odds of AL (odds ratio (OR) 0.80 (95% CI: 0.37-1.76)). There was no association between the anastomotic technique and bowel dysfunction (LARS score: OR 1.14 (95% CI: 0.58-2.27) and CCFFIS: OR -0.08 (95% CI: -1.63 to -1.46)). CONCLUSIONS: This is the first study examining anastomotic type and the risk of AL and bowel dysfunction in a long-term perspective beyond 3 years among patients who underwent AR. The anastomosis type did not show any association for AL or bowel dysfunction.