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Do Anastomotic Leaks Impair Postoperative Health-related Quality of Life After Rectal Cancer Surgery? A Case-matched Study

Marinatou, Annezo M.D.; Theodoropoulos, George E. M.D., Ph.D.; Karanika, Styliani M.D.; Karantanos, Theodoros M.D.; Siakavellas, Spiridon M.D.; Spyropoulos, Basileios G. M.D., Ph.D.; Toutouzas, Konstantinos M.D., Ph.D.; Zografos, George M.D., Ph.D.

doi: 10.1097/DCR.0000000000000040
Original Contributions: Colorectal/Anal Neoplasia

BACKGROUND: Anastomotic leaks after colorectal resections for cancer are a leading cause of postoperative morbidity, mortality, and long hospital stay. Few data exist on the potentially deleterious effect of the anastomotic leaks after proctectomy for cancer on patient health-related quality of life.

OBJECTIVE: The aim of this study was to explore the effect of clinically evident anastomotic leaks on health-related quality of life after rectal cancer excision.

DESIGN: This is a case-matched study.

SETTINGS: This study was conducted in a Greek academic surgical department.

PATIENTS: Included were 25 patients undergoing low anterior resection complicated by an anastomotic leak (Clavien classification II, n = 14, and III, n = 11) and 50 patients undergoing low anterior resection with an uncomplicated course.

MAIN OUTCOME MEASURES: Health-related quality-of-life data were prospectively collected at fixed assessment time points (baseline, 3, 6, and 12 months postoperatively) by the use of validated questionnaires (Medical Outcomes Study Short Form 36, Gastrointestinal Quality of Life Index, European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30, and European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-CR29).

RESULTS: “Leak” patients required a longer hospitalization. Although the numbers of initially constructed defunctioning loop ileostomies were not significantly different between cases and controls, “leak” patients were required to remain with a stoma significantly more often at all postoperative assessment time points. No differences were observed in the baseline scores between the 2 groups. Physical function of “leak” patients was significantly worse at all postoperative assessment time points. At 6 and 12 months, their emotional and social function and overall quality-of-life scores were significantly decreased in comparison with the patients with an uncomplicated course. “Leak” patients experienced significantly more “stoma-related problems” and “sore skin” around the stoma site.

LIMITATIONS: Limited number of patients, restriction of follow-up to the end of the first year, and heterogeneity in terms of the presentation, severity, and management of anastomotic leaks were the limitations of this study.

CONCLUSIONS: Anastomotic leaks have an adverse effect on postoperative health-related quality of life.

Colorectal Unit, First Department of Propaedeutic Surgery, Athens Medical School, Athens, Greece

Financial Disclosure: None reported.

Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: George E. Theodoropoulos, M.D., Ph.D., Athens Medical School, 7 Semitelou St, GR-11528 Athens, Greece. E-mail:

© 2014 The American Society of Colon and Rectal Surgeons