Standardized pelvic drainage of anastomotic leaks following anterior resection without diversional stomas.
BACKGROUND
Anastomotic leakage is a serious complication in rectal cancer surgery. More than one third of rectal cancer patients with low anterior resection (LAR) will receive defunctional stomas during primary operation.


METHODS
Six hundred thirty-nine consecutive rectal cancer patients, whose tumors were located 5 to 12 cm from the anal verge, were treated with LAR. A standardized pelvic drainage for all these patients and selective irrigation for patients with leakage were conducted, and defunctional stoma was used as a salvage modality. All the anastomoses were all extraperitonealized during primary operations.


RESULTS
The anastomotic leakage rate was 7.04%. Male gender and location of tumor were found to be risk factors for leakage in patients with LAR. The overall stoma rate was 1.88%. Nearly 75% of leakage could be cured by irrigation-suction without surgical intervention. Severe complications, such as peritonitis, fistula, and obstruction, were strong predictors of irrigation failure.


CONCLUSIONS
Extraperitonealized anastomosis and pelvic drainage obtained a very low rate of defunctional stoma for LAR. Pelvic irrigation-suction was an effective modality to resolve anastomotic leakage.
Peng
Junjie
J
Department of Colorectal Surgery, Cancer Hospital of Fudan University, Shanghai, China.
Lu
Jiade
J
Xu
Ye
Y
Guan
Zuqing
Z
Wang
Minghe
M
Cai
Guoxiang
G
Cai
Sanjun
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D004322:Drainage / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000601:surgery*; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D054047:Surgical Stomas / Q000473:pathology; D007507:Therapeutic Irrigation / Q000592:standards; D016896:Treatment Outcome