title: Outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain, and risk factors for anastomotic leakage.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. bolloon@hotmail.com
authors.forename: Varut
authors.initials: V
authors.lastname: Lohsiriwat
authors.forename: Darin
authors.initials: D
authors.lastname: Lohsiriwat
authors.forename: Wiroon
authors.initials: W
authors.lastname: Boonnuch
authors.forename: Vitoon
authors.initials: V
authors.lastname: Chinswangwatanakul
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.forename: Woramin
authors.initials: W
authors.lastname: Riansuwan
authors.forename: Narong
authors.initials: N
authors.lastname: Lert-akyamanee
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000075202:Contraindications; D004322:Drainage; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D054047:Surgical Stomas; D016896:Treatment Outcome