title: Selective treatment of rectal cancer with single-stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality.
abstract: OBJECTIVE
  The surgical treatment of low rectal cancer commonly includes low pelvic anastomoses with coloanal or ultralow colorectal anastomoses. Anastomotic leak rates in low pelvic anastomoses range from 4 to 26%. Many surgeons opt to routinely create a diverting ostomy to reduce the extent of morbidity should an anastomotic leak occur. The intent of our study was to determine if our policy of selected diversion is safe.
  
  
  METHODS
  A retrospective chart review of 66 rectal cancer patients who underwent proctectomy and low pelvic anastomoses -- less than 6 cm from anal verge, with or without a diverting ostomy -- was undertaken. Temporary diverting stomas were utilized at the discretion of the attending surgeon primarily based on subjective criteria. The main outcome was postoperative complications.
  
  
  RESULTS
  Forty-nine patients (78% preoperatively irradiated) were treated with a one-stage operation, whereas 17 (53% preoperatively irradiated) underwent reconstruction with proximal diversion. The mean anastomotic height for patients with a single stage procedure was 3.8 cm above the anal verge versus 2.6 for patients with a two-stage procedure (p = 0.076). Complication rates were lower in patients who did not undergo diversion (29% vs 47%, p = 16). With regard to anastomotic-associated complications for single stage versus two stage, complication rates were 8% versus 18%, respectively (p = 0.27).
  
  
  CONCLUSIONS
  Low pelvic anastomoses in rectal cancer patients can be safely performed as a single-stage procedure, reserving the use of diversion for select cases.
authors.affiliation: Division of Colon and Rectal Surgery, University of California, Irvine Medical Center, Irvine, CA, USA.
authors.forename: Allen P
authors.initials: AP
authors.lastname: Kong
authors.forename: Justin
authors.initials: J
authors.lastname: Kim
authors.forename: Alicia
authors.initials: A
authors.lastname: Holt
authors.forename: Viken
authors.initials: V
authors.lastname: Konyalian
authors.forename: Richard
authors.initials: R
authors.lastname: Huynh
authors.forename: Sejal M
authors.initials: SM
authors.lastname: Udani
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Ravin R
authors.initials: RR
authors.lastname: Kumar
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome