The Impact of Anastomotic Leakage on Anal Function Following Intersphincteric Resection.

Abstract

Data regarding anastomotic leakage (AL) following intersphincteric resection (ISR) are lacking. We aimed to evaluate the effect of AL on anal function in a retrospective review of patients who developed AL following ISR. We evaluated 341 consecutive patients who underwent ISR between 2000 and 2012. Patients were classified into three groups: anastomotic dehiscence (AD), major AL (Clavien-Dindo grade III+), or control (<grade III or no AL). Functional assessment was performed at 3, 6, 12, and 24 months after defecation through the preserved anus, and the Wexner score was calculated. Among patients who underwent ISR for low rectal cancer (anal verge, 3.7 ± 1.3 cm), 59 (17%) developed AL. Of these, 13 patients were classified as AD and 36 as major AL. The rate of the 3-year stomal reversal was significantly lower in the major AL (78.6%) and AD groups (61.5%) than in the control group (88.7%; p < 0.01). Furthermore, the anastomotic stricture rate was higher in the AL and AD groups than in the controls (16.7 and 38.5 vs. 1.8%, respectively; p < 0.01). Wexner scores in the major AL group were poor during the early period, but were similar to the control group at the 2-year follow-up. In contrast, Wexner scores in the AD group remained high, even after 2 years. Patients with major AL following ISR had poor anal function that recovered over 2 years, as long as AD was not present. These findings suggest that patients with major AL require a long-term follow-up for anal function.