Postoperative inflammatory response and local recurrence after rectal cancer surgery complicated by anastomotic leakage
Oskar Grahn, Jobbe Lemmens, Pieter Tanis, Hans de Wilt, Martin RutegårdAbstract
Introduction
Anastomotic leakage after rectal cancer resection has been associated with impaired oncological outcomes, including an increased risk of local recurrence. Whether this effect is due to an increased inflammatory response or by the severity of the leak remains unclear, and where a chronic infection from a non-healed presacral sinus remains a specific concern.
Methods
This was a retrospective cohort study based on the multinational TENTACLE Rectum database, including patients with anastomotic leakage after anterior resection for rectal cancer between 2014 and 2018. Postoperative C-reactive protein (CRP) values during postoperative days 1–14 were collected, and the maximum value was used as a marker of inflammatory response. Anastomotic outcome at one year was categorized as a healed anastomosis, a non-healed anastomosis with a presacral sinus or a dismantled anastomosis. The primary outcome was local recurrence within one year, analysed using multivariable regression models.
Results
A total of 2034 patients were included. Higher postoperative CRP levels were associated with an increased risk of local recurrence (HR per 100 mg/L 1.14, 95% c.i. 1.01–1.29, P = 0.030). This association remained after adjustment for leak severity according to ISREC grade. Non-healed anastomosis with a presacral sinus was not associated with an increased local recurrence risk.
Discussion
Postoperative inflammatory response was associated with local recurrence in this international cohort of patients with anastomotic leakage after rectal cancer resection. This association was independent of leak severity. These findings suggest that postoperative inflammation itself, rather than the leak severity, may contribute to adverse oncological outcomes.