Analysis of treatment methods and relapse factors of postoperative anastomotic stenosis in colorectal cancer

Background: Anastomotic stenosis following surgical intervention for colorectal cancer is a frequently encountered complication. Nevertheless, the optimal approach to effectively manage anastomotic stenosis at varying distances from the anal margin remains uncertain. The primary objective of this research endeavor was to explore the risk factors associated with recurrent anastomotic stenosis subsequent to colorectal cancer surgery, as well as to evaluate potential strategies for its management.

Methods: The present study retrospectively analyzed the clinical data and treatment outcomes of 244 patients who underwent colorectal surgery and were subsequently diagnosed with anastomotic stenosis. The patients were categorized into two groups based on the location of anastomotic stenosis relative to the anal verge: the low anastomotic stenosis group (n = 107) and the high anastomotic stenosis group (n = 137).

Results: The severity of anastomotic stenosis was found to be significantly higher in the low anastomotic stenosis group compared to the high anastomotic stenosis group (71.0% vs 57.7%, P = 0.031). Furthermore, the high anastomotic stenosis group exhibited a greater inclination toward opting for endoscopic treatment when it came to the choice of treatment for anastomotic stenosis (62.8% vs 27.1%, P < 0.001). In addition, logistic regression analysis showed that stenosis length ≥ 0.8 cm (odds ratio = 0.481; 95% CI = 0.248-0.936; P = 0.031) and lymph node metastasis (OR = 0.559, 95%CI = 0.313-0.998, P = 0.049) were independent risk factor for recurrence of anastomotic stenosis. Finally further build colorectal surgery of tumor recurrent anastomotic stenosis nomogram prediction model, using the internal validation and calculation model of the receiver-operating characteristic curve (ROC) area under curve (AUC) to evaluate the reliability and accuracy of the model.

Conclusion: There exist variations in the severity of anastomotic stenosis, the extent of stenosis, and the selection of treatment modalities across different anatomic locations. Regarding the choice of anastomotic treatment, patients with elevated anastomotic stenosis exhibited a preference for endoscopic intervention. Furthermore, a multivariate analysis showed that stenosis length equal to or greater than 0.8 cm and lymph node metastasis were autonomous risk factors for recurrence of benign stenosis after colorectal cancer surgery.