title: Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer.
abstract: BACKGROUND
  The aim of this study was to assess the rate of permanent diversion in patients undergoing coloanal anastomosis after neoadjuvant therapy for rectal cancer.
  
  
  METHODS
  We performed a retrospective review of patients with rectal cancer who underwent a total mesorectal excision of a tumor within 9 cm of the anal verge.
  
  
  RESULTS
  There were 201 patients who underwent resection with coloanal anastomosis, with a mean follow-up period of 51 months. The average tumor distance from the anal verge was 7 cm (range, 4-9 cm). Neoadjuvant therapy was administrated in 145 patients, 47 had no radiation, and 9 received radiation postoperatively. Thirty-two patients (16%) had long-term complications including incontinence, fistulas, and strictures. Twenty-five patients (12%) had recurrent disease, 16 of these were local recurrence. The total rate of permanent diversion was 29 (14%). Reasons for diversion included local recurrence in 12 patients (6%), complications in 10 patients (5%), and poor function in 7 patients (3%).
  
  
  CONCLUSIONS
  Poor bowel function, late complications, and local recurrence all contribute to permanent diversion after a coloanal anastomosis. Neoadjuvant therapy in conjunction with a total mesorectal excision and coloanal anastomosis leads to acceptably low permanent diversion rates in the vast majority of patients.
authors.affiliation: Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA.
authors.forename: R Scott
authors.initials: RS
authors.lastname: Nelson
authors.forename: Elena
authors.initials: E
authors.lastname: Boland
authors.forename: B Mark
authors.initials: BM
authors.lastname: Ewing
authors.forename: Garnet J
authors.initials: GJ
authors.lastname: Blatchford
authors.forename: Charles
authors.initials: C
authors.lastname: Ternent
authors.forename: M
authors.initials: M
authors.lastname: Shashidharan
authors.forename: N Anh
authors.initials: NA
authors.lastname: Tran
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beaty
authors.forename: Alan G
authors.initials: AG
authors.lastname: Thorson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult