Causes of anastomotic leakage after rectal cancer surgery

The most important issue in surgical treatment of rectal cancer is postoperative complications. Postoperative anastomotic fistula is the most common and most serious complication of rectal cancer. The main reasons for this phenomenon are as follows.

1. Patient's physical factors

The patient's own conditions include advanced age, physical weakness, malnutrition, hypoproteinemia, etc. If the patient's physical indicators are poor and the body tissue repair ability is poor, it will be unfavorable for the patient's postoperative recovery. Especially when the preoperative plasma albumin is lower than 25g/L, the probability of anastomotic leakage is very high.

2. Intestinal obstruction

About 19% of patients with rectal cancer and intestinal obstruction develop anastomotic fistula. The cancer causes intestinal stenosis and obstruction of varying degrees. Due to malnutrition for various reasons before surgery, the intestinal wall is severely damaged, edema may occur, and the proximal intestine is significantly dilated. The intestinal calibers at both ends of the anastomosis are asymmetrical, and an exact anastomosis cannot be guaranteed. At the same time, patients with concomitant intestinal obstruction have a higher incidence of postoperative intestinal infection, which increases the possibility of anastomotic fistula.

3. Insufficient blood supply to the anastomosis

Cancer may cause necrosis of some blood vessels in the intestinal cavity, resulting in insufficient blood supply to the anastomotic site and anastomotic fistula after surgery.

4. Tumor location

To be precise, it is the distance between the tumor and the anus. Generally, the cancer is closer to the anus, that is, the tumor is located low and the operation is difficult. If some problems occur during the operation, such as unskilled operation of the stapler, incomplete closure of the rectal stump, excessively thick fat tissue mixed in the anastomosis, etc., these may lead to the occurrence of anastomotic fistula.