Elective resection and anastomosis for colorectal cancer: a prospective audit of mortality and morbidity 1976-1998.
BACKGROUND
The purpose of this paper is to audit the morbidity and mortality for colorectal cancer after open elective resection and anastomosis by a single colorectal surgeon (MK), with reference to any differences between intraperitoneal (IPA) and extra-peritoneal anastomoses (EPA).


METHODS
The prospective documentation of postoperative complications was compiled by the surgeon, charge nurses and a research assistant (PB). The operations were performed in three hospitals between 1976 and 1998.


RESULTS
Some 1392 consecutive patients were treated electively by 1418 resections with anastomosis. There were 23 postoperative deaths (1.6%). Significant adverse events, which were potentially avoidable, occurred in 10 (43.5%) of the patients who died. The morbidity rate was 41.6%. Clinical anastomotic leaks occurred more frequently in EPA (27/581, 4.7%) than in IPA (2/827, 0.2%; P < 0.0001). Anastomotic leak caused the death of two patients (0.14%).Routine prophylactic anticoagulation did not decrease the incidence of pulmonary embolism. Significant thrombophlebitis at the intravenous cannula site occurred in 54 patients (3.8%), wound infection in 29 (2.1%), and postural peripheral nerve injury in the upper limbs occurred in 11 patients (0.8%). Thirty-eight patients (2.7%) were returned to the operating theatre for 42 unscheduled operations.


CONCLUSIONS
Mortality associated with elective resection of colorectal cancer with anastomosis is principally related to age, cardio-vascular disease and avoidable adverse events. A wide range of complications may follow this type of surgery, especially after extra peritoneal operations. A classification of anastomotic leaks is suggested to assist in comparisons of this complication which remains a significant concern following extra peritoneal anastomoses.
Killingback
Mark
M
Sydney Adventist Hospital. killingback@bigpond.com.au
Barron
Prudence
P
Dent
Owen
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data