PURPOSE:Standard adjuvant treatment for stage III colorectal cancer (CRC) combines intravenous oxaliplatin with a fluoropyrimidine, either with intravenous 5-fluorouracil with folinic acid oxaliplatin, capecitabine (CAPOX). This study aims to describe the toxicity of these two regimens in patients with a diverting stoma. METHODS:We conducted a retrospective, single-center study of patients with stage III CRC who had a diverting stoma and received adjuvant treatment with either FOLFOX or CAPOX between January 2016 and July 2023. Clinical characteristics and treatment details were extracted from electronic health records. The primary end point was the rate of hospitalization during adjuvant chemotherapy. Secondary end points included treatment compliance and toxicity. RESULTS:A total of 87 patients with CRC and a diverting stoma received treatment with either CAPOX (n = 37) or modified FOLFOX regimen: oxaliplatin, 5-fluorouracil, folinic acid (mFOLFOX6)  (n = 50). No patient had dihydropyrimidine dehydrogenase deficiency. Baseline clinical characteristics were similar between groups. The hospitalization rate was 35% with CAPOX and 18% with FOLFOX (P = .07). Most hospitalizations occurred during the first cycles of adjuvant treatment and were primarily related to digestive toxicities. Higher hospitalization rates with CAPOX were observed across all subgroups, regardless of sex, age, performance status, or renal function. CONCLUSION:Patients with a diverting stoma who receive adjuvant chemotherapy with fluoropyrimidines and oxaliplatin are at higher risk of severe digestive toxicities when treated with the CAPOX regimen. The mFOLFOX6 regimen appears to be safer alternative in this population.

Peutz-Jeghers syndrome (PJS) is a very rare autosomal dominant disorder associated with an increased risk of gastrointestinal and gynecological cancers. However, risk estimates vary widely, due to the small size and retrospective nature of most studies, which may introduce recruitment bias. Accurate data are needed to improve cancer screening. The aim of this study was to estimate cancer risks in a large cohort of PJS patients. A total of 161 patients were included, half of whom were prospectively monitored as part of a surveillance network. This makes it one of the largest cohorts of PJS patients to date. We estimated age-dependent cancer risks using the Genotype Restricted Likelihood (GRL) method to correct for ascertainment bias. Standardized mortality ratios (SMRs) were calculated to assess mortality. PJS patients showed an increased risk of cancer, particularly early-onset cancers (cumulative risk before age 70: 18.1% in men, 36.8% in women). This resulted in excess mortality, especially among young women. The most frequent cancers were breast, lung, and cervical cancers. Small bowel was the site with the highest relative risk. Although the risk of pancreatic adenocarcinoma (PDAC) was elevated, it was much lower than had been reported previously (relative risk at age 50: 11.8). Degenerated intraductal papillary mucinous neoplasms (IPMN) may contribute to the risk of PDAC in PJS, while this carcinogenesis pathway accounts for only 10% of PDACs overall. We report an unexpectedly high risk of lung adenocarcinoma, calling into question the relevance of lung cancer screening in PJS.

Background The optimal management of primary tumor (PT) in microsatellite instability-high metastatic colorectal cancer patients treated with immune checkpoint inhibitors (ICIs) remains unclear. Patients and methods We retrospectively analyzed a prospective, single-center cohort to assess PT outcomes in this setting. Results Among 210 patients, 21% received first-line ICI; we focused on 33 patients (16%) without prior PT resection at ICI initiation. Early progressive disease (<6 months) occurred in 10 patients (5%), with eight deaths (<1 year); two underwent surgery for symptomatic PT. Among the remaining 23 patients (11%) with disease control (≥6 months), 15 had PT resection due to clinical events (n = 5) or for non-symptomatic reasons (n = 10), including seven with pathological complete response and eight with residual tumor. Eight patients had no PT resection, including two with metastatic and/or local progressive diseases. After a median 75-month follow-up, only six patients (3%) remained progression-free with PT in place and no residual endoscopic tumor. Conclusions If PT is left in place at ICI initiation, close monitoring is required due to its specific evolution. Resection may be indicated for symptomatic stenosis. Prospective trials are needed to define the role of endoscopic monitoring and indication of PT resection in first-line ICI.

Abstract To evaluate whether computed tomography (CT) was overused in the early postoperative period in oncologic colorectal surgery. We conducted a single-center retrospective study including all patients who underwent colorectal resection with an anastomosis for colorectal adenocarcinoma between 2018 and 2022. The indications and findings of postoperative abdominopelvic CT scans performed during the initial hospital stay were collected, excluding the CT scans performed after discharge. A total of 1,091 patients were included. The overall morbidity rate was of 32%. Abdominopelvic CT scans were performed in 284 patients (26%), including 25% for isolated C-reactive protein (CRP) elevation without clinical signs. In total, 30% of the scans performed (n = 84) were normal, with 93% of those patients subsequently experiencing no severe postoperative complications. In cases of isolated CRP elevation, the rate of normal abdominopelvic CT scans was of 38%. In the multivariate analysis, we identified 3 factors associated with a normal abdominopelvic CT: scans performed within the first 4 postoperative days (p = 0.004), isolated CRP elevation (p = 0.010), and absence of a diverting ileostomy (p = 0.044). A predictive score based on these factors showed probabilities of a normal CT of 7%, 22%, 35%, and 54% when 0, 1, 2, or 3 factors were present respectively. Among patients with a normal scan, 39% were discharged within 24 hours, rising to 68% when the CT was performed for isolated CRP elevation. Postoperative abdominopelvic CT scans are frequently performed after colorectal surgery, with normal findings in about 1/3 of the cases in our experience. When normal—especially in the context of isolated CRP elevation—abdominopelvic CT scans exclude major complications and help accelerate an earlier and safe patient discharge.

Abstract Immune checkpoint inhibitors (ICIs) have transformed outcomes in microsatellite instability-high (MSI-H) deficient mismatch repair (dMMR) cancers. The influence of germline MMR gene variants on ICI remains unclear. In this single-center study, 93 patients with Lynch syndrome-associated MSI-H/dMMR digestive cancers received ICI monotherapy or combination therapy. Germline MMR variants were classified, and progression-free survival (PFS) was evaluated by gene and variant type. Most patients carried MLH1 or MSH2 variants. At 24 months, estimated PFS was 81.5% for MLH1, 67.2% for MSH2/EPCAM, and 78.6% for MSH6, with no PFS events in MLH1 promoter methylation or PMS2 subgroups. No statistically significant differences in PFS were observed between gene groups. Performance status ≥ 2 was the only factor associated with poorer PFS. Neither MMR gene type nor variant class significantly influenced ICI efficacy in Lynch syndrome-related MSI-H/dMMR digestive cancers, supporting the use of ICIs regardless of germline MMR genotype.

Importance Antibiotic-only management (AOM) for uncomplicated acute appendicitis is increasingly adopted, raising concern about missed appendiceal neoplasms. Objective To assess the prevalence, histologic spectrum, and predictors of incidental appendiceal tumors after appendectomy for acute appendicitis. Design, Setting, and Participants This single-center retrospective cohort study was conducted from January 1, 2013, to December 31, 2021, at the tertiary surgical emergency center at Saint-Antoine Hospital in Paris, France. All consecutive adult patients undergoing appendectomy for acute appendicitis were eligible for inclusion. Data were analyzed in June 2025. Exposure Standard surgical management with appendectomy (no AOM); preoperative clinical variables, laboratory values, and imaging findings were assessed as potential predictors of appendiceal tumors. Main Outcome and Measures Prevalence and histopathological classification of incidental appendiceal neoplasms identified after appendectomy for acute appendicitis and preoperative clinical and radiologic factors associated with aggressive tumors. Results Among the cohort, median (IQR) age was 32 years (25-43), and 999 patients (44%) were female. Among 2293 appendectomies, 37 (1.6%) had malignant or premalignant lesions and 8 (0.3%) had benign nondysplastic lesions. Neuroendocrine tumors (NETs) (n = 22) predominated; all were grade 1 (G1) and smaller than 2 cm, with 19 (86%) measuring 1 cm or less without recurrence after 34 months of follow-up. Other lesions included low-grade appendiceal mucinous neoplasms (n = 5), metastatic tumors (n = 3), goblet cell carcinomas (n = 2), mucinous adenocarcinoma (n = 1), and low-grade dysplastic polyps (n = 4). Compared with nonneoplastic appendicitis, aggressive tumors (putting aside G1 NETs <2 cm and low-grade dysplasia) occurred more often in older patients (median [IQR] age, no malignant lesions: 32 years [25.0-43.0] vs malignant lesions: 45.0 years [37.8-57.2]; P = .03), with longer median symptom duration (no malignant lesions: 2 days vs malignant lesions: 1 day; P < .001), larger median (IQR) appendiceal diameter (no malignant lesions: 11.0 mm [9.0-13.0] vs malignant lesions: 18.0 mm [14.0-25.5]; P < .001), and radiologic suspicion of complicated appendicitis (no malignant lesions: 287 of 2234 [13%] vs malignant lesions: 6 of 11 [55%]; P = .001). In dedicated univariate analysis, NETs could not be distinguished from nonneoplastic appendicitis by any clinical or radiological variables tested. Using eligibility criteria for AOM derived from the univariate analysis (abdominal pain duration <14 days; age <60 years; and on imaging: uncomplicated appendicitis, appendiceal diameter <15 mm, and absence of suspicious appendiceal, peritoneal, hepatic, or bone lesions), none of the patients with aggressive tumors met the entirety of these criteria. However, 17 of 22 small G1 NETs (77%) and 1 of 4 low-grade dysplastic polyps (25%) fulfilled these criteria. By grouping all these selection criteria, 74% of the cohort met eligibility criteria for potential AOM; within the subgroup with uncomplicated appendicitis, 85% would have been eligible. Conclusions and Relevance In this single-center cohort study, incidental appendiceal tumors were mostly small and low-grade NETs; aggressive malignancies were exceptional and occurred in identifiable high-risk profiles. Applied assembled preoperative selection criteria reliably excluded patients with aggressive tumors, thereby supporting the oncologic safety of AOM in rigorously selected individuals.

Les fistules entérocutanées (FEC) représentent une pathologie complexe. Leur prise en charge repose sur une stratégie associant traitement du sepsis, correction des troubles hydro-électrolytiques, optimisation nutritionnelle, bilan anatomique et planification de la prise en charge. L’approche est nécessairement multidisciplinaire (nutritionnistes, stomathérapeutes, radiologues interventionnels, anesthésistes-réanimateurs et chirurgiens). L’appareillage cutané reste un défi et fait appel à une expertise infirmière spécialisée. En nutrition, les recommandations actuelles préconisent 25–35kcal/kg/j avec 1,5 à 2,5g/kg/j de protéines selon la sévérité de la déperdition. La nutrition parentérale a une place centrale à la période initiale. La réinstillation du chyme, lorsqu’elle est réalisable (2 orifices fistuleux individualisables), permet une stimulation distale, un effet de frein iléal, une amélioration des fonctions hépatiques et une préparation à la restauration digestive. La nutrition entérale peut être progressivement augmentée selon la tolérance, et la nutrition orale peut même être envisagée dans certains cas lorsque la fistule est bien contrôlée, avec un réel bénéfice psychologique pour le patient. La prise en charge chirurgicale est le plus souvent différée et une étude récente montre qu’une chirurgie curative précoce (<4 mois) est possible chez certains patients sélectionnés. Ses grands principes sont : viscérolyse complète, mesure des longueurs résiduelles, résection de la zone fistulisée, et le plus souvent une anastomose. La fermeture pariétale est parfois difficile, imposant des techniques de reconstruction allant de la suture simple à la séparation de composants ou aux lambeaux complexes. Lorsque le patient est éligible, le taux de succès global de la chirurgie curative pour FEC postopératoire avoisine les 80 %, avec un taux de récidive d’environ 17 % et un taux de stomie définitive proche de 10 %. Le succès dépend fortement de l’étiologie. Les données actuelles suggèrent que l’expertise du centre, l’optimisation préopératoire, et une bonne sélection des patients sont les éléments déterminants du succès. Il ne faut pas négliger l’impact économique et psychologique de cette pathologie. Une FEC double en moyenne le coût d’une hospitalisation. Une communication claire et honnête avec le patient dès le début du parcours est essentielle.

Enterocutaneous fistulas (ECF) represent a complex condition. Management strategy is based on a combination of treatment of sepsis, correction of fluid and electrolyte imbalances, nutritional optimization, anatomical assessment, and management planning. The approach is necessarily multidisciplinary (nutritionists, enterostomal therapists, interventional radiologists, anesthesiologists, intensive care specialists, and surgeons). Fitting of skin prostheses remains a challenge and requires specialized enterostomal nursing expertise. Current nutritional recommendations are for 25-35kcal/kg/day with 1.5 to 2.5g/kg/day of protein, depending on the severity of muscle wasting. Parenteral nutrition plays a central role in the initial period. Re-instillation of chyme, when feasible (proximal and distal individualized fistula orifices), provides downstream intestinal stimulation, an ileal brake effect, improved liver function, and preparation for restoration of intestinal continuity. Enteral nutrition can be gradually increased as tolerated, and oral nutrition can even be considered in certain cases when the fistula is well controlled. This has real psychological benefits for the patient. Surgical management is most often delayed, but a recent study shows that early curative surgery (<4months) is possible in certain selected patients. Main principles of curative surgery include complete viscerolysis, measurement of residual lengths, resection of the fistulated area, and most often, re-anastomosis. Parietal closure is sometimes difficult, requiring reconstructive techniques ranging from simple sutures to component separation or complex flaps. When the patient is eligible for curative surgery, the overall success rate for postoperative ECF is around 80%, with a recurrence rate of approximately 17% and a permanent stoma rate of nearly 10%. Success is highly dependent on the etiology. Current data suggest that center expertise, preoperative patient optimization, and careful patient selection are the determining factors for success. The economic and psychological impact of this condition should not be overlooked. An ECF doubles the cost of hospitalization on average. Clear and honest communication with the patient from the outset is essential.

OBJECTIVE:Evaluate the feasibility of early radical enterocutaneous fistula (ECF) surgery. BACKGROUND:After failure of medical treatment for ECF, the optimal timing of surgical reintervention remains debated. METHODS:Patients undergoing radical ECF surgery to treat postoperative small bowel- ECFs and/or colon-ECFs (2005-2024) were retrospectively included. Success was defined as no remnant ECF or ECF-related stoma at the most recent follow-up and absence of 90-day postoperative mortality. Early ECF surgery was defined as planned surgery (urgent procedures excluded) occurring within 4 months of the last abdominal procedure. RESULTS:Among 200 patients (median 62 years; 43% female; 40% American Society of Anesthesiologists ≥ 3), 77% had small bowel-ECF only, 12% colon-ECF only and 11%. both. Eighty-two percent were referred, with a median delay of 48 days [interquartile range (IQR): 8-200] after ECF diagnosis. Referral center management lasted 34 days (IQR: 3-90), with 10% exceeding 120 days. After excluding 22 emergency procedures, early ECF surgery was performed in 39% (70/178). Early-surgery patients had fewer respiratory comorbidities (9% vs 21%; P = 0.036) and shorter ECF diagnosis-to-transfer interval (16 days vs 145; P = 0.001). Early surgery did not impact operative time ( P = 0.312), mortality ( P = 0.091), severe morbidity ( P = 0.867), and reoperations ( P = 0.511). After a median follow-up of 12 months, the success rate was 74% (permanent stomas = 11%; recurrence = 17%). American Society of Anesthesiologists ≥ 3 ( P = 0.012) and malignancies ( P = 0.010) were independently associated with failure on multivariate analysis, whereas ECF-origin ( P = 0.924) and surgical timing ( P = 0.438) were not. CONCLUSIONS:For postoperative small bowel/colon ECF, the success rate of radical surgery is 74%. Early surgery seems feasible (39%) and does not compromise success. Further prospective studies are needed.

BACKGROUND:Delayed coloanal anastomosis for treating rectovaginal fistulas focuses on optimizing healing by postponing the coloanal anastomosis until after the vaginal repair. This study aimed to evaluate the success rate, morbidity, and functional outcomes of this strategy. METHODS:This retrospective study included all patients who underwent delayed coloanal anastomosis for rectovaginal fistula between 2010 and 2023 across 16 GRECCAR-affiliated colorectal centers. RESULTS:A total of 78 patients (median age: 54.5 years) were included. The main cause of rectovaginal fistula was chronic leakage from colorectal or coloanal anastomosis (67%). The median time interval between the rectovaginal fistula diagnosis and delayed coloanal anastomosis was 9.0 months (interquartile range: 5.0-17.0 months). A total of 40% (31 of 78) of patients underwent delayed coloanal anastomosis after the failure of at least 1 previous treatment attempt. The overall morbidity, major morbidity, and anastomotic leakage occurrence after delayed coloanal anastomosis were 45%, 23%, and 17%, respectively. After a median follow-up of 31 months, the success rate of delayed coloanal anastomosis (healing of rectovaginal fistulas with preservation of bowel continuity) was 81% (63 of 78). No preoperative or intraoperative factors, including pelvic radiotherapy (P = .331) or failure of a previous treatments before delayed coloanal anastomosis (P = .982), were predictive of failure. In cases of anastomotic leakage after delayed coloanal anastomosis, the success rate decreased to 23% (3 of 13) compared with the success rate of 92% (60 of 65) in the absence of anastomotic leakage (P < .001). A total of 42% (24 of 57) of patients reported severe low anterior resection syndrome or remained with a stoma because of poor functional outcomes. CONCLUSION:Delayed coloanal anastomosis demonstrates a high success rate as high as 81% in treating complex rectovaginal fistulas. However, it is linked to significant postoperative morbidity and functional sequelae.

OBJECTIVE:To evaluate the necessity of postoperative antibiotics following appendectomy for acute appendicitis (AA), particularly in patients with intra-abdominal fluid, and to identify factors associated with postoperative infections. BACKGROUND:Postoperative antibiotic use after appendectomy remains controversial, especially in the presence of intra-abdominal fluid. While some surgeons prescribe antibiotics empirically, there is no consensus on whether they reduce the risk of postoperative infections in patients with intra-abdominal fluid accumulation. METHODS:A retrospective study was conducted at Saint Antoine Hospital (2013-2020) analyzing 1539 patients with AA (abscess and peritonitis were excluded). The presence of intra-abdominal fluid, antibiotic use, and postoperative outcomes were recorded. Risk factors for infections were identified through univariate and multivariate analysis. RESULTS:Intra-abdominal fluid was present in 880 patients (57.2%), with 474 exhibiting serosanguinous intra-abdominal fluid and 406 presenting purulent intra-abdominal fluid. Postoperative antibiotics were administered to 18.1% of patients, yet no significant difference in infection rates was found between patients with and without peritoneal intra-abdominal fluid. The study identified 3 independent risk factors for postoperative infection: American Society of Anesthesiologists score [hazard ratio (HR) = 5.129, P = 0.004], symptom duration >2 days (HR = 2.290, P = 0.029), and the presence of appendicolith (HR = 2.204, P = 0.042). Postoperative antibiotic use did not significantly prevent infections, but inadequate antibiotic therapy was associated with higher rates of readmission and infectious outcomes. CONCLUSIONS:Routine use of postoperative antibiotics for AA, even with intra-abdominal fluid, may not be necessary. Further research is needed to determine whether a targeted antibiotic approach based on risk factors for postoperative infections can improve outcomes without exacerbating antibiotic resistance.

Objective:Evaluate the feasibility of early radical enterocutaneous fistula (ECF) surgery.Background:After failure of medical treatment for ECF, the optimal timing of surgical reintervention remains debated.Methods:Patients undergoing radical ECF surgery to treat postoperative small bowel- ECFs and/or colon-ECFs (2005-2024) were retrospectively included. Success was defined as no remnant ECF or ECF-related stoma at the most recent follow-up and absence of 90-day postoperative mortality. Early ECF surgery was defined as planned surgery (urgent procedures excluded) occurring within 4 months of the last abdominal procedure.Results:Among 200 patients (median 62 years; 43% female; 40% American Society of Anesthesiologists >= 3), 77% had small bowel-ECF only, 12% colon-ECF only and 11%. both. Eighty-two percent were referred, with a median delay of 48 days [interquartile range (IQR): 8-200] after ECF diagnosis. Referral center management lasted 34 days (IQR: 3-90), with 10% exceeding 120 days. After excluding 22 emergency procedures, early ECF surgery was performed in 39% (70/178). Early-surgery patients had fewer respiratory comorbidities (9% vs 21%; P = 0.036) and shorter ECF diagnosis-to-transfer interval (16 days vs 145; P = 0.001). Early surgery did not impact operative time (P = 0.312), mortality (P = 0.091), severe morbidity (P = 0.867), and reoperations (P = 0.511). After a median follow-up of 12 months, the success rate was 74% (permanent stomas = 11%; recurrence = 17%). American Society of Anesthesiologists >= 3 (P = 0.012) and malignancies (P = 0.010) were independently associated with failure on multivariate analysis, whereas ECF-origin (P = 0.924) and surgical timing (P = 0.438) were not.Conclusions:For postoperative small bowel/colon ECF, the success rate of radical surgery is 74%. Early surgery seems feasible (39%) and does not compromise success. Further prospective studies are needed.

Single-port laparoscopy has been mainly studied for colonic cancer or cholecystectomy. Little is known about the cosmetic outcome for patients with Crohn’s disease who are the best candidates for single-port surgery. This study aimed to assess cosmetic outcomes with single-port laparoscopy (SPL) vs. multiport laparoscopy (MPL) after ileocolic resection for Crohn’s disease. This was a retrospective case-control study of a consecutive monocentric cohort. The study was conducted at a tertiary colorectal surgery referral centre. All consecutive patients who underwent an ileocolic resection by laparoscopy between 2012 and 2020 were included. The main outcomes measures, body image and cosmesis after surgery, were evaluated with a validated questionnaire. Secondary endpoints were conversion, morbidity, length of hospital stay and incisional hernia. Two hundred and six patients were included (SPL, n = 65, 32

Objectives:To quantify how surgical complications impact hospital revenue when their effect on the volume of admissions is considered. Design:Retrospective analysis of comprehensive administrative data. Setting:Three university hospitals in France. Participants:54 637 inpatient stays between 2017 and 2023 in 4 surgical departments (abdominal, orthopedics, thoracic, and urology). Main outcome measures:Stays were categorized by their diagnosis-related group and occurrence of one or more complications, according to International Classification of Diseases, 10th revision diagnosis codes. First, data were aggregated monthly to determine the impact of variation in the monthly mean length of stay (LOS) on the monthly volume of admissions, using an instrumental variable strategy. Second, LOS and revenue per patient were compared for patients with and without complications. Finally, an estimation of the impact of complications on total revenue was performed. Results:A total of 54 637 stays were analyzed, with 9735 (17.8%) experiencing at least one complication. The mean LOS was 8.7 days and the mean revenue per patient was €7602. The instrumental variable analysis, designed to account for unobserved confounders, showed that a decrease of 10% in the monthly mean LOS increased the monthly volume of admissions by 9% (95% CI (5.1% to 13.0%), p<0.01). Complications increased the LOS by 10.9 days (95% CI: (8.95 to 13.1), p<0.01) and revenue per patient by €7912 (95% CI: (6420 to 9087), p<0.01), but decreased daily revenue per patient by €211 (95% CI: (-384 to -83.0), p<0.01). Over the study period, the estimated potential loss induced by complications ranged from 6.6% (95% CI (6.3% to 7.0%), p<0.01) to 9.1% (95% CI (8.8% to 9.4%), p<0.01) of actual revenue. Departments with higher complication rates incurred larger potential losses. Conclusions:Surgical complications reduce total revenue by crowding out short stays that generate more daily revenue. This challenges the consensus that complications are a boon for hospital revenue, instead implying that they shrink hospital net margins (ie, revenue minus costs).

PURPOSE:Management of anastomotic leakage (AL) following rectal surgery is not standardized. The aim was to evaluate the trends of clinical practice management and outcome of AL over time. METHOD:All patients with grade B symptomatic AL after rectal surgery from January 2012 to January 2022 in two centers were included. Diagnostic and treatment management was compared in 3 time periods: 2012-2014, 2015-2018 and 2019-2021. Success was defined as a completely healed, preserved and functional anastomosis. Univariate and multivariate analyses were used to identify predictive factors of success. RESULTS:In total, 194 patients with symptomatic AL were included. The overall success rate was 57%. The use of CRP dosage and CT scan for diagnosis increased overtime from 44% and 81% in 2012-2014, 75% and 95% in 2015-2018, 69% and 100% in 2019-2021, respectively. The use of anal examination under general anesthesia also increased over time: 48% in 2012-2014, 35% in 2015-2018, 60% in 2019-2021 (P=0.025). Success rate increased significantly: 51% in 2012-2014, 52% in 2015-2018, 77% in 2019-2021 (P=0.026). In multivariate analysis, absence of preoperative radiotherapy (OR=2.137, IC95%(1.08-4.22), P=0.029) and most recent period of care (OR=0.319, IC95%(0.12-0.82), P=0.017) were independent factors associated to the healing of AL. CONCLUSION:Across time, relevant diagnostic and therapeutic changes are observed in the management of AL after rectal cancer surgery, translating in improved outcomes with a higher rate of anastomotic preservation.