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

Br J Surg. 2005 Feb;92(2):211-6. doi: 10.1002/bjs.4806.

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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical
  • Clinical Competence
  • Colostomy / methods
  • Female
  • Humans
  • Ileostomy / methods
  • Male
  • Middle Aged
  • Postoperative Complications / surgery
  • Prospective Studies
  • Prosthesis Failure
  • Rectal Neoplasms / radiotherapy
  • Rectal Neoplasms / surgery*
  • Retrospective Studies
  • Risk Factors
  • Surgical Stomas*
  • Treatment Outcome