Abstract
Aim
Although advances in treatment have improved sphincter-preservation rates in rectal
cancer, the incidence of benign anastomotic strictures has also increased. This retrospective
single-institution study sought to determine the incidence of benign anastomotic strictures
and the factors associated with their successful resolution following treatment.
Methodology
From January 2010 to December 2019, consecutive patients undergoing endoscopic dilatation
and/or surgery for benign anastomotic strictures developing after radical sphincter-sparing
resections for rectal cancer were evaluated. To model the relationship between outcomes
and potential independent variables, sequential univariate and multivariate analyses
were performed using binary logistic regression.
Results
Of 2069 rectal cancer patients undergoing sphincter-preserving surgery, benign anastomotic
strictures were identified in 110 (5.3%). Mean age was 48.2 ± 13.98 years; 73.6% were
male. Distal tumor-extent was within 6 cm of the anal verge in 60%; 80.9% patients
received neoadjuvant radiotherapy. Surgical approach in 71.8% was open, 74.5% being
anterior or low anterior resections and 70.9% of anastomoses stapled. Covering stoma
was performed in 91.8%. On follow-up, strictures of median length 4 cm were identified
at median 3 cm from the anal verge. Endoscopic dilatation was offered in 89.1%, whereas
9.1% required redo-surgery. Overall, 49.1% experienced sustained stricture-resolution
with dilatation and 45.4% required re-intervention. At last follow-up, 72.7% were
stoma-free. On multivariate analysis, good performance status, absence of anastomotic
leak, and short-segment strictures predicted successful stricture-resolution.
Conclusion
Endoscopic dilatation is an effective first-line therapy, with redo anastomosis used
to salvage those failing conservative measures. Adverse performance status, anastomotic
leak and greater stricture length may predict detrimental outcomes in terms of stricture
resolution.
Keywords
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Article info
Publication history
Published online: March 02, 2023
Accepted:
February 22,
2023
Received in revised form:
December 25,
2022
Received:
September 8,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
