title: Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer.
abstract: OBJECTIVE
  The aim of the present study was to investigate the characteristics of patients who developed delayed anastomotic leakage (DAL) following sphincter-preserving surgery for rectal cancer. We evaluated the following factors: (1) the incidence of DAL, (2) the clinical features of patients who developed DAL, (3) the risk factors for DAL, and (4) treatment outcomes.
  
  
  METHODS
  We reviewed the case histories of 1,838 rectal cancer patients who had undergone curative resection with sphincter preservation and without protective stoma formation between January 2000 and December 2006. DAL was defined as the development of a pelvic abscess or fistula around the anastomosis more than 3 weeks post-surgery in patients without tumor recurrence who had resumed a normal diet and defecation.
  
  
  RESULTS
  In 1.3% (24/1,838) of the patients, DAL developed on median postoperative day 99 (range 22-2,069). Pelvic abscess (50%) and anastomotic-vaginal fistula (41.7%) were the most common causes of DAL. Independent risk factors for the development of DAL were: (1) female gender (hazard ratio 3.03; 95% CI 1.06-8.8), (2) low-level anastomosis (< or = 4 cm from the anal verge) (hazard ratio 5.76; 95% CI 1.37-22.39), and (3) preoperative chemoradiation therapy (hazard ratio 4.56; 95% CI 1.4-14.92). Stoma formation was performed in all of the 24 patients. The 3-year stoma-retention rate in patients with DAL was significantly higher than in patients with early anastomotic leakage (72.2% vs 17.5%, P < 0.001).
  
  
  CONCLUSIONS
  DAL following sphincter-preserving surgery for rectal cancer occurred relatively frequently in our sample and was associated with female gender, a low level of anastomosis, and preoperative radiotherapy. DAL patients required long-term or permanent stomas.
authors.affiliation: Department of Colonic and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
authors.forename: Ui Sup
authors.initials: US
authors.lastname: Shin
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D001003:Anal Canal / Q000473:pathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome
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