Management of anastomotic leak following restorative rectal cancer resection—a multi-centre retrospective audit in Ireland

Anastomotic leak (AL) following rectal cancer resection significantly impacts outcomes. Currently its management management is not standardised. This study reviews AL management following restorative rectal cancer resection in Ireland. A retrospective review of centres’ own databases and HIPE-coded data between 1st January 2020-31st December 2023 was performed to identify AL patients and their characteristics and interventions. The primary outcome of “success” in management was defined as the resolution of pelvic sepsis and/or healing of the anastomotic defect. Secondary outcomes included long-term stoma rates, length of stay, 30-day mortality dates, major morbidity rates, disease-free and overall survival. 36 patients were identified across four centres with the median follow up being 26.9 months. Nine (25.0%) patients received conservative management (CM), fifteen (41.7%) were treated with drainage procedures (DP)(66.7% percutaneous radiological drains, 33.3% transanal drains) and twelve had surgery (4, 11.1%, had anastomosis conserving surgery-ACS- and 8, 22.2%, anastomotic takedown-SAT). The success rate of these interventions was CM:77.7%, DP:73.3%, ACS:100.0%, and SAT:75.0%. Long-term stoma rates were CM:20.0%, DP:46.7%, ACS:50.0%, and SAT:87.5%. Length of stay was CM:18 days (IQR 12–21), DP:23 days (14–30), ACS:26 days (19–35), and SAT: 27 days (7–45). There was no 30-day mortality. There was no significant difference in disease-free and overall survival by management (p = 0.509, p = 0.395 respectively). Management for AL following rectal cancer resection varies but is generally successful. While patient factors and institutional expertise influences management opportunities and strategies, some investment, including in data collection and analysis, could better standardise care in and between centres.