Treatment of early anastomotic bleeding after low anterior resection for rectal carcinoma

Objective To summarize the risk factors and treatments for early anastomotic bleeding following low anterior resection for rectal cancer. Methods We retrospectively analyzed 418 patients who underwent low anterior resection for rectal cancer at Shougang Hospital of Peking University from January 2010 to December 2016. The data were analyzed by the χ2 and Fisher exact tests to figure out the relationship of early anastomotic bleeding with age, gender, tumor stage, tumor location and distance from anal edge, and laparotomy or laparoscopy. Then we sorted the treatments for the bleeding and observed their effectiveness in the management of early anastomotic bleeding. Results Twenty-one (5.02%) cases suffered from early postoperative anastomotic bleeding. Compared with female cases, the incidence of early anastomotic bleeding in male cases was much higher (P=0.01). Patients whose lesions were located very low, with a distance from the anal edge<6 cm, were prone to anastomotic bleeding after operation (χ2=4.76, P=0.03). There were no significant differences in the incidence of early anastomotic bleeding between groups of age ≥ 65 vs<65 years old, stageⅠ-Ⅱ vs stage Ⅲ, tumor diameter ≥ 3 cm vs<3 cm, receiving neoadjuvant chemotherapy vs not receiving, or open vs laparoscopy surgery (χ2=0.00, P=1.00; χ2=1.13, P=0.29; χ2=1.08, P=0.30; P=0.47; χ2=0.00, P=1.00; P=0.29). On the first postoperative day, 11 cases presented anal bleeding in the ICU. Endoscopic examination revealed clots, active bleeding, or staxis on the anastomosis. After electronic coagulation or clipping bleeding was stopped in ten patients, and one patient received emergency sigmoidectomy after anastomotic perforation during the endoscopic procedure. The remaining ten cases of bleeding occurred in the period of 3-10 days postoperatively, of which four were cured after endoscopic treatment with electronic coagulation or clipping, two improved after conservative treatment only, and another four suffered from anastomotic necrosis and dehiscence (two improved after abscess drainage and two underwent a surgical procedure). There were no death cases in our study. One patient experienced multi-organ dysfunction, which improved after ICU treatment for 35 days. This case recovered finally but had a prolonged hospital stay. Conclusion To prevent early anastomotic bleeding is the main goal of postoperative management for patients with rectal cancer. If early anastomotic bleeding occurs, early recognition and endoscopic examination and treatment as soon as possible may be good solutions. Key words: Low anterior resection; Rectal cancer; Anastomotic bleeding; Postoperative complications