# Diagnostic value of CT scan findings for anastomotic leakage after low anterior resection without ileostomy in rectal cancer

## TL;DR

This study shows that CT scans can help detect anastomotic leakage after rectal cancer surgery, but they work best when combined with clinical symptoms.

## Contribution

The study identifies specific CT scan features, like large perianastomotic collections and peritonitis, as reliable indicators of anastomotic leakage.

## Key findings

- Complex perianastomotic collections larger than 5 cm on CT scans are strongly associated with anastomotic leakage.
- Generalized peritonitis observed on CT scans correlates with the presence of anastomotic leakage.
- Clinical symptoms like fever and leukocytosis, when combined with CT findings, improve diagnostic accuracy.

## Abstract

Anastomotic leakage (AL) is one of the most serious complications following colorectal surgery, particularly in patients who have undergone low anterior resection (LAR) for rectal cancer without a protective ileostomy. The early detection of AL is crucial, as it can significantly impact the patient’s recovery and survival rates. This study aims to assess the diagnostic accuracy of abdominal Computed Tomography(CT) scans in identifying AL among rectal cancer patients post-LAR. This retrospective cohort study was conducted at the Tehran Surgical Research Center and included 42 patients with rectal cancer who underwent LAR after neoadjuvant chemoradiotherapy. All patients received an abdominal CT scan on the fifth postoperative day. The presence of AL was confirmed based on clinical symptoms, radiological findings, and the necessity for reoperation. The study focused on evaluating specific CT findings, such as perianastomotic collections, to determine their correlation with AL. The analysis revealed that certain CT scan findings, particularly complex collections larger than 5 cm in proximity to the anastomosis site and signs of generalized peritonitis, were significantly associated with the presence of AL. These findings were particularly important in cases where patients also exhibited clinical symptoms like fever and leukocytosis. The presence of these CT indicators often necessitated reoperation to address the leakage. The results of this study suggest that while abdominal CT scans are a valuable tool in the early detection of AL, the interpretation of these scans must be done in conjunction with clinical symptoms. The study highlights the importance of considering the size of perianastomotic collections and the presence of systemic symptoms for an accurate and timely diagnosis of AL. Future research should further investigate the potential of CT scans in improving outcomes for patients undergoing LAR for rectal cancer.