Specific Septic Complications after Rectal Cancer Surgery: A Critical Multicentre Study

Simple Summary Rectal surgery remains burdened by a considerable rate of septic complications. The data of this study show that preoperative radiochemotherapy at the level of the lower and middle rectum allows minimally invasive surgery techniques to be successfully practiced at this level. However, at the same time, this constitutes a contributing factor to postoperative locoregional septic, functional genitourinary and continence complications. This represents the price to be paid for a more conservative and functional surgery. We advocate a personalised treatment that takes both oncological and functional outcomes into account. In this sense, the participation of the patient in the decision-making process is essential, because this makes her/him aware of the possible impact of the treatment on her/his life. The postoperative septic complications in gastrointestinal surgery impact immediate as well as long-term outcomes, which lead to reinterventions and additional costs. The authors presented the experience of three surgery clinics in Romania regarding the specific septic complications occurring in patients operated on for rectal cancer. The study group comprised 2674 patients who underwent surgery over a 5-year period (2017-2021). Neoplasms of the middle and lower rectum (76%) were the majority. There were 85% rectal resections and 15% abdominoperineal excisions of the rectum. In total, 68.54% of patients were operated on laparoscopically, and 31.46% received open surgery. Without taking wound infections into account, 97 (3.67%) patients had abdominal-pelvic septic complications. The aim was to evaluate the causes of the complications. The percentage of suppurations after surgery of the rectum treated by radiochemotherapy was considerably higher than after surgery of the non-radiated upper rectum. The fatality rate was 5.15%. The risk of fistulas was significantly associated with the preoperative treatment, tumour position and type of intervention. Sex, age, TNM stage or grade were not significant at 0.05 the threshold. The risk of fistulas is reduced with low anterior resection, but the gravity of these complications is higher in the lower rectum compared with the superior rectum. Preoperative radiochemotherapy is a contributing factor to septic complications.