title: Low colorectal anastomosis after radical pelvic surgery: a risk factor analysis.
abstract: OBJECTIVE
  This study was conducted to analyze our experience with low (8-12 cm above the anal verge) and very low (<6 cm above the anal verge) colorectal resection and primary anastomosis at the time of radical en bloc resection of pelvic malignancies.
  
  
  METHODS
  A retrospective review of 77 patients undergoing supralevator pelvic exenteration with low colorectal resection and primary anastomosis in our gynecologic oncology service was carried out. Data were obtained from patient medical records and from the tumor registry. Univariate statistical analysis of the data was used.
  
  
  RESULTS
  The distribution of primary malignancies in this cohort was as follows: 33 (43%) recurrent or primary cervical carcinomas, 27 (35%) primary or recurrent ovarian carcinomas, 7 (9%) recurrent vaginal carcinomas, 4 (5%) endometrial carcinomas, 3 (4%) colon carcinomas, and 3 (4%) cases of stage IV endometriosis. Forty patients underwent total pelvic exenteration, and 37 patients underwent posterior exenteration. Thirty-six patients in the total pelvic exenteration group had a history of pelvic irradiation. Twelve (30%) of these patients had development of breakdown or fistulas of the anastomosis. Six of the 12 patients (50%) had undergone protective colostomy. Thirty-seven patients underwent posterior exenteration with primary anastomosis for ovarian cancer, endometrial cancer, colon cancer, or endometriosis, and only 1 of these had received pelvic irradiation. This patient did not have a protective colostomy, and a rectovaginal fistula developed. In addition, there were 3 other breakdowns in the posterior exenteration group. Finally, the presence of preoperative ascites did not appear to alter the breakdown rate of the anastomosis among the patients with ovarian cancer who underwent cytoreductive surgery.
  
  
  CONCLUSIONS
  Radical resection of pelvic tissue remains a crucial part of the armamentarium of the gynecologic oncologist. Previous pelvic irradiation appears to be a major risk factor (35% vs 7.5%) for anastomotic breakdown and fistulas, independent of the presence of a protective colostomy. The overall results appear to be better for patients undergoing this procedure as part of a posterior exenteration.
authors: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami School of Medicine, FL 33136, USA.
authors: R
authors: R
authors: Mirhashemi
authors: H E
authors: HE
authors: Averette
authors: R
authors: R
authors: Estape
authors: R
authors: R
authors: Angioli
authors: R
authors: R
authors: Mahran
authors: L
authors: L
authors: Mendez
authors: G
authors: G
authors: Cantuaria
authors: M
authors: M
authors: Penalver
mesh_terms: D000714:Anastomosis, Surgical; D015331:Cohort Studies; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D010385:Pelvic Exenteration; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors