Morbidity following surgical resection of early rectal cancer

Abstract Introduction When deciding on treatment for early rectal cancer, available options must be considered based on both the risk for recurrence and the risk of postoperative morbidity. This retrospective registry study aimed to investigate morbidity and mortality following surgical resection of T1 and T2 rectal cancer. Method Population-based registry study using the Swedish Colorectal Cancer Registry, including all pathologically staged T1 and T2 rectal cancer cases between 2011 and 2022 treated with anterior resection with or without diverging ileostomy, abdominoperineal resection or Hartmann’s procedure. Complications were registered according to the Clavien-Dindo (CD) classification and considered severe if CD³III. Patient characteristics were analysed using uni- and multivariate logistic regression to determine risk factors for complications. Result 2548 rectal cancer patients, 761 with T1 and 1787 with T2, were included. A total of 922 complications were registered among 694 (27.2%) patients. 300 (11.8%) patients had one or more severe complications. 92 patients (3.6%) required intensive care, and 188 (7.4%) had a reoperation. 1063 (41.7%) patients received a temporary stoma (diverging ileostomy) and 1009 (39.6%) a permanent stoma. Anastomotic leakage occurred in 98 (6.4%) of 1539 patients undergoing anterior resection. 90-day mortality was 36 (1.4%). Male sex (OR 1.73, 95% CI 1.34-2.23), ASA III-IV (OR 1.53, 95% CI 1.18-1.99) and BMI>30 (OR 1.41, 95% CI 1.06-1.86) were significant (p<0.05), independent risk factors for complications. Discussion Surgical resection of early rectal cancer has a high rate of complications and stomas, which should be considered when deciding between treatment options.