Diabetes and anastomotic leakage after anterior resection: a nationwide registry-study
Christoffer Örtenwall, Koen Simons, Jennifer Park, Charlotta Larsson, Pamela Buchwald, Peter Matthiessen, Björn Eliasson, Eva Angenete, Martin RutegårdAbstract
Introduction
Anastomotic leakage after anterior resection for rectal cancer is a serious and common complication. Meta-analyses suggest a link between diabetes and leakage, but studies lack detail on diabetes duration and treatment. In this population-based study, we aimed to assess the impact of diabetes, as well as medication and long-term glycaemic control, on the incidence and severity of anastomotic leakage.
Methods
This registry-based study included patients from the Swedish Colorectal Cancer Registry who underwent anterior resection for rectal cancer between 2011–2023. Diabetes status were extracted through cross-linking with the National Diabetes Registry. Prevalent diabetes was investigated as a predictive factor. Mixed-effects logistic and ordinal regression was used, considering clustering effects and confounding from demographics, tumour characteristics, and operative approach.
Results
A total of 8160 patients were included, of whom 1023 (13%) had diabetes. Among the latter, 141 (14%) experienced anastomotic leakage within 30 days of surgery, compared to 696 (11%) in patients without diabetes. Diabetes was demonstrated to be predictive of any leakage, with an adjusted OR of 1.40 (95% c.i.: 1.14–1.73). Similarly, diabetes was associated with a common OR of 1.39 (95% c.i. 1.12–1.74), indicating that the odds of a shift from no leakage to leakage without reoperation or from leakage without reoperation to leakage with reoperation, was 1.39 times greater in diabetics.
Discussion
Prevalent diabetes is an independent risk factor of anastomotic leakage after anterior resection for rectal cancer, with a corresponding dose-response relationship for leakage severity. Further analyses are needed to define subgroups at particular risk.