To Örebro University

Introduction: Anastomotic leakage after anterior resection for rectal cancer is a common and potentially dangerous complication, resulting in morbidity and sometimes mortality. The rate of failure to rescue (FTR), or death after leakage, has previously been reported at 6-7% within 90 days. The aim of this study was to investigate the incidence of and predictive factors for FTR in a modern population-based cohort.

Method: This retrospective, nationwide registry-based study included patients from the Colorectal Cancer Database Sweden (CRCBaSe) who had undergone anterior resection for rectal cancer between 2007 to 2021. Patients without a registered leakage were excluded. Predictive factors were investigated in a multiple logistic regression model and included age, American Society of Anaesthesiologists’ classification, sex, obesity, cardiovascular disease, diabetes, education, hospital volume and defunctioning stoma use. The primary endpoint was FTR within 90 days of surgery.

Result: A total of 637 patients with leakage were identified, of whom 19 (2.8%) died within 90 days. High age was predictive of FTR (odds ratio (OR): 1.14; 95% CI: 1.06–1.23). Male sex (OR: 1.76; 95% CI: 0.52–5.90) and cardiovascular disease (OR 2.59; 95% CI: 0.90–7.47) were also related to FTR, but not statistically significantly.

Discussion: The FTR within 90 days after anterior resection for rectal cancer is low in routine Swedish healthcare. The only strong predictor for FTR was high age, while ASA classification unexpectedly did not confer any predictive value in presence of other covariates.