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Dig Surg. 2008;25(3):191-7. doi: 10.1159/000140688. Epub 2008 Jun 23.

Outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain, and risk factors for anastomotic leakage.

Author information

1
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. bolloon@hotmail.com

Abstract

BACKGROUND/AIMS:

To evaluate the outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain and to determine factors influencing anastomotic leakage.

METHODS:

We investigated 170 patients undergoing elective sphincter-saving operation without protective stoma and pelvic drain during 2003-2006 in a single institution. Early postoperative outcomes were evaluated. 17 independent patient-, tumor-, and treatment-related variables were analyzed by a multivariate model to determine their association with anastomotic leakage.

RESULTS:

The patients' median age was 64 years. Median tumor height was 8 cm (range 3-15) from the anal verge. Overall 30-day mortality rate was 1.2%. Postoperative complications were diagnosed in 38 patients (22%) including 14 cases of anastomotic leakage (8.2%), of which 10 cases (71%) required surgical intervention. Tumor height within 5 cm from the anal verge was the only independent factor for leakage (OR 4.04; 95% CI 1.25-13.08).

CONCLUSION:

A sphincter-saving operation without a protective stoma and pelvic drain can be performed safely in the vast majority of rectal cancer patients. Tumor height within 5 cm from the anal verge is an independent risk factor for anastomotic leakage. Thus, the routine use of a protective stoma and pelvic drainage might be unnecessary.

PMID:
18577863
DOI:
10.1159/000140688
[Indexed for MEDLINE]

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