Risk factors for anastomotic failure after total mesorectal excision of rectal cancer

KCMJ Peeters, RAEM Tollenaar, CAM Marijnen, EK Kranenbarg, WH Steup, T Wiggers, HJ Rutten, CJH van de Velde*, Dutch Colorectal Cancer Grp

*Corresponding author for this work

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    Abstract

    Background: Anastomotic leakage is a major complication of rectal cancer surgery. The aim of this study was to investigate risk factors associated with symptomatic anastomotic leakage after total mesorectal excision (TME).

    Methods: Between 1996 and 1999, patients with operable rectal cancer were randomized to receive short-term radiotherapy followed by TME or to undergo TME alone. Eligible Dutch patients who underwent an anterior resection (924 patients) were studied retrospectively.

    Results: Symptomatic anastomotic leakage occurred in 107 patients (11.6 per cent). Pelvic drainage and the use of a defunctioning stoma were significantly associated with a lower anastomotic failure rate. A significant correlation between the absence of a stoma and anastomotic dehiscence was observed in both men and women, for both distal and proximal rectal tumours. In patients with anastomotic failure, the presence of pelvic drains and a covering stoma were both related to a lower requirement for surgical reintervention.

    Conclusion: Placement of one or more pelvic drains after TME may limit the consequences of anastomotic failure. The clinical decision to construct a defunctioning stoma is supported by this study.

    Original languageEnglish
    Pages (from-to)211-216
    Number of pages6
    JournalBritish Journal of Surgery
    Volume92
    Issue number2
    DOIs
    Publication statusPublished - Feb-2005

    Keywords

    • LOW ANTERIOR RESECTION
    • RANDOMIZED-TRIAL
    • PREOPERATIVE RADIOTHERAPY
    • COLORECTAL ANASTOMOSIS
    • DEFUNCTIONING STOMA
    • ANAL ANASTOMOSIS
    • PELVIC DRAINAGE
    • LEAKAGE
    • MULTICENTER
    • CARCINOMA

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