The types of anastomotic leakage that develop following anterior resection for rectal cancer demonstrate distinct characteristics and oncologic outcomes

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Abstract
The types of anastomotic leakage that develop following rectal cancer surgery and their impact on long-term outcomes are not well documented. This study aimed to compare the clinical characteristics of various types of anastomotic leakage after anterior resection in rectal cancer patients and evaluate their impact on the long-term oncologic outcomes. This study analyzed data obtained from 2510 consecutive patients who underwent anterior resection for rectal cancers. Of these patients, 141 (5.6 %) developed anastomotic leakage. Three types of leakage were categorized according to presentation: generalized peritonitis (type I), localized peritonitis (type II), and fistula or chronic sinus (type III). The clinical characteristics and oncologic outcomes were compared. Type I leakage was the most common (I 44.7 %, n = 63; II 30.5 %, n = 43; III 24.8 %, n = 35). Type III occurred more frequently in women (p = 0.001) and patients with low rectal cancer (p < 0.001). Patients with type II or III leakage more frequently underwent radiation therapy (p < 0.001) and diverting ostomy (p < 0.001). Leakage management differed according to the type of leakage (p < 0.001). The local recurrence-free survival rate was significantly lower in patients with type II and III leakage (p = 0.014). The clinical characteristics and oncologic results are distinct for each type of anastomotic leakage. Only a type II or III leakage increases the risk of local recurrence. Each type of leakage should thus be considered a different disease entity.

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