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Br J Surg. 2005 Feb;92(2):211-6.

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

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1
Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.

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.

PMID:
15584062
DOI:
10.1002/bjs.4806
[Indexed for MEDLINE]
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