Background Anastomotic leakage (AL) is a major postoperative complication following rectal surgery, leading to increased morbidity, poor oncologic outcomes, and reduced quality of life. While significant data exist regarding rectal cancer management in developed countries, studies from developing nations remain limited. This study aims to evaluate the incidence of AL in rectal cancer surgery during the introduction of minimally invasive surgery (MIS) at a referral center in a developing country.

Methods A retrospective study was conducted at Ibn-Sina University Hospital from 2001 to 2022, including patients who underwent curative rectal cancer surgery. Data were analyzed descriptively with continuous variables presented as mean, median, and standard deviation, while categorical variables were reported as frequencies and proportions. Univariable analysis identified risk factors associated with AL, using appropriate statistical tests for continuous and categorical variables.

Results A total of 306 patients were included, with 39.9% undergoing minimally invasive procedures and 60.1% open surgeries. AL occurred in 16.3% of cases, with higher rates (19.1%) before 2014, compared to 9.1% afterward. Pre-2014, tumor location (p=0.011), surgical resection (R0 vs. R1, p=0.002), and the use of a diverting stoma (p=0.008) were associated with AL. Post-2014, no significant risk factors were identified for AL.

Discussion This study provides valuable insights into rectal cancer surgery outcomes in a developing country. AL rates aligned with global data, showing a reduction after the implementation of MIS. The risk factors identified before 2014 can be attributed to surgical complexity, while the low AL rate post-2014 suggests improved surgical techniques.

Conclusion Assessing the risk of AL is vital for early intervention and optimal surgical planning. The study highlights the advantages and challenges of implementing minimally invasive surgery in developing countries, emphasizing the need for more data in such settings.

The authors have declared no competing interest.

This study did not receive any funding

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Ethics committee IRB of Faculte de Medecine et de Pharmacie de Rabat gave ethical approval for this work

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Conflict of interest: None to declare.

Financial disclosure: None to declare.

Competing interest: We have no conflict of interest to report.

All data produced in the present study are available upon reasonable request to the authors