Mortality and morbidity after surgery of mid and low rectal cancer. Results of a French prospective multicentric study.
BACKGROUND
The aim of the study was to assess both mortality and morbidity following resection of mid and low rectal cancers in a French prospective multicentric study.


METHODS
From June to September 2002, consecutive patients undergoing resection for cancer of the mid- or lower rectum were prospectively included in a multicentric study. Both postoperative mortality and morbidity were recorded. Multivariate statistical analysis was performed in order to assess risk factors predictive of postoperative morbidity.


RESULTS
238 patients with a mean age of 66 +/- 13 years (range: 26-88) were included. Neoadjuvant radiotherapy was performed in 68% of the patients. Total mesorectal excision was performed in 218 patients (92%), of whom 151 (63%) had a sphincter saving procedure. Six patients died (2.5%). Overall postoperative morbidity rate was 43%, including anastomotic leakage (11%) and reoperation (5%). Mean hospital-in-stay was 20 +/- 16 days (range: 3191). Four independent risk factors of morbidity were found: perioperative fecal contamination (OR = 3.9 [1.1; 13.5]), mean operating time longer than 6 hours (OR = 4.5 [1.7; 12.1]), ASA score > 2 (OR = 3.2 [1.6; 7.9]), and smocking (OR = 3.3 [1.2; 8.9]).


CONCLUSIONS
Resection of cancer involving the middle or lower rectum with sphincter saving procedures was possible in two-thirds of the patients and was associated with 2.5% mortality and 43% morbidity.
Service de Chirurgie Digestive, Hôpital Lariboisière, Paris.
Arnaud
A
Alves
Yves
Y
Panis
Pierre
P
Mathieu
Fabrice
F
Kwiatkowski
Karem
K
Slim
Georges
G
Mantion
D000368:Aged; D001003:Anal Canal; D005243:Feces; D005260:Female; D005602:France; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020360:Neoadjuvant Therapy; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D012307:Risk Factors; D012907:Smoking