Risk Factors of Anastomotic Fistulas after Low Rectal Cancer Surgery

Introduction: The surgical treatment of rectal cancer is constantly improving in order to preserve the anal sphincter. However, the risk of postoperative complications is still present. Amoung these, anastomotic leakage increases morbidity, hospitalization time and costs, prolongs the recovering time and increases the risk of a second surgery. Methods: We studied a group of 26 patients affected with middle and lower rectal cancer with sphincter-sparing surgery on the Surgical Department of Coltea Hospital in Bucharest (23 patients with colo-rectal anastomosis T-T with mechanical staplers and 3 patients with coloanal anastomosis). We analyzed the surgical technique, neoadjuvant treatment, the patient’s condition and postoperative complications. Results: Patients were enrolled into 3 groups: 6 (23.07%) patients with colo-rectal anastomosis without any other protection of the anastomosis, 18 (69.23%) patients with protective ileostomy and 2 (7.69%) patients with multiperforated transanal transanastomotic tube. 2 (7.69%) patients were operated laparoscopically. We have identified 2 (7.69%) anastomotic fistula with low flow closed under conservative treatment. Conclusions: The risk of anastomotic fistula after sphincter-sparing surgery in case of low rectal cancer is still elevated and it depends on many factors related to both patient status and the surgical technique. The lower localisation of the rectal cancer increases the risk of anastomotic fistula. ”This work received financial support through the project entitled "CERO – Career profile: Romanian Researcher", grant number POSDRU/159/1.5/S/135760, cofinanced by the