Anastomotic leakage increases the risk of major low anterior resection syndrome 3 years after rectal cancer surgery
(2026) In Colorectal Disease 28(3).- Abstract
Background: Anastomotic leakage is a serious complication following anterior resection for rectal cancer and may increase the risk of long-term bowel dysfunction. This study aimed to assess the long-term impact of anastomotic leakage on major low anterior resection syndrome (major LARS) at a uniform follow-up time. Methods: We conducted a nationwide cohort study using the Swedish Colorectal Cancer Registry. Patients who underwent anterior resection for rectal cancer between 2015 and 2017 received the validated LARS questionnaire by mail 3 years after surgery. The primary outcome was major LARS among patients without a permanent stoma. Propensity score weighting was used to adjust for confounding, with covariates chosen using a directed... (More)
Background: Anastomotic leakage is a serious complication following anterior resection for rectal cancer and may increase the risk of long-term bowel dysfunction. This study aimed to assess the long-term impact of anastomotic leakage on major low anterior resection syndrome (major LARS) at a uniform follow-up time. Methods: We conducted a nationwide cohort study using the Swedish Colorectal Cancer Registry. Patients who underwent anterior resection for rectal cancer between 2015 and 2017 received the validated LARS questionnaire by mail 3 years after surgery. The primary outcome was major LARS among patients without a permanent stoma. Propensity score weighting was used to adjust for confounding, with covariates chosen using a directed acyclic graph. Sensitivity analyses included a dose–response analysis based on reoperation and an evaluation of a composite outcome of major LARS or permanent stoma. Results: Of 1778 patients contacted, 1178 responded (66.2%). Among 1033 stoma-free patients, 52 (5.0%) had experienced a symptomatic anastomotic leak. Major LARS was reported in 69.2% and 52.9% of patients with and without leakage, respectively. Symptomatic anastomotic leakage increased the risk of major LARS (OR 2.09; 95% CI: 1.13–3.87) and this risk was higher in patients requiring reintervention (OR 2.78; 95% CI: 0.87–8.91) and when including permanent stoma in the outcome (OR 3.90; 95% CI: 2.20–6.91). Conclusion: Anastomotic leakage significantly increased the risk of major LARS 3 years after anterior resection for rectal cancer. These findings underscore the importance of preventing anastomotic leakage to reduce long-term functional morbidity in patients who survive rectal cancer.
(Less)
- author
- Gerdin, Anders ; Häggström, Jenny ; Park, Jennifer ; Lydrup, Marie Louise LU ; Matthiessen, Peter ; Jutesten, Henrik LU ; Sandberg, Sofia ; Angenete, Eva and Rutegård, Martin LU
- organization
- publishing date
- 2026-03
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- anastomotic leakage, anterior resection, bowel dysfunction, low anterior resection syndrome, patient-reported outcomes, rectal cancer
- in
- Colorectal Disease
- volume
- 28
- issue
- 3
- article number
- e70423
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- scopus:105033004114
- pmid:41839822
- ISSN
- 1462-8910
- DOI
- 10.1111/codi.70423
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2026 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
- id
- f9663e81-80e8-44b2-8d94-7415536543f8
- date added to LUP
- 2026-04-29 14:31:06
- date last changed
- 2026-06-10 17:58:05
@article{f9663e81-80e8-44b2-8d94-7415536543f8,
abstract = {{<p>Background: Anastomotic leakage is a serious complication following anterior resection for rectal cancer and may increase the risk of long-term bowel dysfunction. This study aimed to assess the long-term impact of anastomotic leakage on major low anterior resection syndrome (major LARS) at a uniform follow-up time. Methods: We conducted a nationwide cohort study using the Swedish Colorectal Cancer Registry. Patients who underwent anterior resection for rectal cancer between 2015 and 2017 received the validated LARS questionnaire by mail 3 years after surgery. The primary outcome was major LARS among patients without a permanent stoma. Propensity score weighting was used to adjust for confounding, with covariates chosen using a directed acyclic graph. Sensitivity analyses included a dose–response analysis based on reoperation and an evaluation of a composite outcome of major LARS or permanent stoma. Results: Of 1778 patients contacted, 1178 responded (66.2%). Among 1033 stoma-free patients, 52 (5.0%) had experienced a symptomatic anastomotic leak. Major LARS was reported in 69.2% and 52.9% of patients with and without leakage, respectively. Symptomatic anastomotic leakage increased the risk of major LARS (OR 2.09; 95% CI: 1.13–3.87) and this risk was higher in patients requiring reintervention (OR 2.78; 95% CI: 0.87–8.91) and when including permanent stoma in the outcome (OR 3.90; 95% CI: 2.20–6.91). Conclusion: Anastomotic leakage significantly increased the risk of major LARS 3 years after anterior resection for rectal cancer. These findings underscore the importance of preventing anastomotic leakage to reduce long-term functional morbidity in patients who survive rectal cancer.</p>}},
author = {{Gerdin, Anders and Häggström, Jenny and Park, Jennifer and Lydrup, Marie Louise and Matthiessen, Peter and Jutesten, Henrik and Sandberg, Sofia and Angenete, Eva and Rutegård, Martin}},
issn = {{1462-8910}},
keywords = {{anastomotic leakage; anterior resection; bowel dysfunction; low anterior resection syndrome; patient-reported outcomes; rectal cancer}},
language = {{eng}},
number = {{3}},
publisher = {{John Wiley & Sons Inc.}},
series = {{Colorectal Disease}},
title = {{Anastomotic leakage increases the risk of major low anterior resection syndrome 3 years after rectal cancer surgery}},
url = {{http://dx.doi.org/10.1111/codi.70423}},
doi = {{10.1111/codi.70423}},
volume = {{28}},
year = {{2026}},
}