Abstract
Anastomotic leakage remains a major complication in colorectal surgery. Although several risk factors have been identified, the specific risks associated with TaTME procedures require further clarification. The aim of this study was to determine the frequency of anastomotic leakage after TaTME and to identify factors influencing leakage rates. Out of 237 patients who underwent TaTME, 229 received an anastomosis. Seventeen were excluded from further analysis—14 due to lack of leakage assessment before ileostomy closure and 3 due to missing follow-up data—resulting in a final cohort of 212 patients. Cases were analysed with respect to anastomotic technique and other variables potentially affecting the incidence of anastomotic leakage. Data were obtained from a prospectively maintained institutional database. The mean tumour distance from the anorectal junction (ARJ) was 2.92 cm (± 1.56). Anastomotic leakage occurred in 27 patients (12.74%). The only statistically significant risk factor for leakage was the type of anastomosis: leakage occurred in 18.28% of patients with hand-sewn anastomosis and in 8.47% of those with stapled anastomosis. Tumour height indirectly influenced the leakage rate, as hand-sewn anastomosis was used predominantly in lower tumours (1.78 cm vs. 3.82 cm from the ARJ). Anastomotic leakage rates after TaTME are comparable to those reported for other rectal cancer surgical techniques. Leakage risk is primarily determined by the type of anastomosis and, indirectly, by tumour height. TaTME appears to be a feasible option for selected patients in experienced centres, although further validation is required.
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The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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B.K. conceptualized and designed the study, collected clinical data, and drafted the manuscript. D.R. performed the statistical analysis and contributed to the interpretation of the results. M.B. supervised the entire project and critically revised the manuscript for important intellectual content. M.K. contributed to data collection and participated in the literature review. P.L. provided clinical insight, assisted in data interpretation, and reviewed the final version of the manuscript. All authors read and approved the final manuscript.
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The study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Bioethics Committee of the Lower Silesian Medical Chamber in Wrocław, Poland (decision number 03/BNBO/2025). Additional institutional approval was granted by the Director of the Lower Silesian Center for Oncology, Pulmonology and Hematology. The requirement for informed consent was waived by the Bioethics Committee of the Lower Silesian Medical Chamber in Wrocław, Poland due to the retrospective and non-interventional nature of the study and the use of anonymised data.This manuscript was prepared in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Due to the retrospective and non-interventional nature of the study, it was not registered in a clinical trial registry.
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Kapturkiewicz, B., Kazanowski, M., Lesiak, P. et al. Incidence and risk factors for anastomotic leakage after transanal total mesorectal excision in a retrospective cohort of 212 patients. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40735-9
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DOI: https://doi.org/10.1038/s41598-026-40735-9
