Objective: The aim of this study was to investigate patients with symptomatic anastomotic leakage diagnosed after hospital discharge.
Method: Patients (n = 234) undergoing low anterior resection of the rectum for cancer who were included in a prospective multicentre trial (NCT 00636948) and who developed symptomatic anastomotic leakage diagnosed after hospital discharge (late leakage, LL; n = 18) were identified. Patient characteristics, operative details, recovery on postoperative day 5, length of hospital stay, and how the leakage was diagnosed were recorded. A comparison with those who did not develop symptomatic leakage (no leakage, NL; n = 189) was made. The minimum follow up was 24 months.
Results: In the LL patients the median age was 69 years, 61% were female patients, and 6% had stage IV cancer disease. On postoperative day 5, the LL group had a postoperative course similar to the NL group regarding temperature, oral intake and bowel function. The proportion of patients on antibiotic treatment on postoperative day 5, regardless of indication, was 28% in the LL compared with 4% in the NL group (P < 0.001). The median initial hospital stay was 10 days for both groups. When readmission for any reason was added, the hospital stay rose to a median of 21.5 and 13 days in the LL and the NL groups respectively (P < 0.001).
Conclusion: Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection of the rectum for cancer is not uncommon and has an immediate clinical postoperative course which may appear uneventful.
Trial registration: ClinicalTrials.gov NCT00636948.