title: Anterior resection for rectal carcinoma - risk factors for anastomotic leaks and strictures.
abstract: OBJECTIVE
  To determine the incidence and factors responsible for anastomotic leaks and stricture following anterior resection (AR) and its subsequent management.
  
  
  METHODS
  Retrospective analysis of data from 108 patients with rectal carcinoma who underwent AR or low anterior resection (LAR) to identify the various preoperative, operative, and post operative factors that might have influence on anastomotic leaks and strictures.
  
  
  RESULTS
  There were 68 males and 40 females with an average of 47 years (range 21-75 years). The median distance of the tumor from the anal verge was 8 cm (range 3-15 cm). Sixty (55.6%) patients underwent handsewn anastomosis and 48 (44.4%) were stapled. The median operating time was 3.5 h (range 2.0-7.5 h). Sixteen (14.6%) patients had an anastomotic leak. Among these, 11 patients required re-exploration and five were managed expectantly. The anastomotic leak rate was similar in patients with and without diverting stoma (8/60, 13.4% with stoma and 8/48; 16.7% without stoma). In 15 (13.9%) patients, resection margins were positive for malignancy. Nineteen (17.6%) patients developed anastomotic strictures at a median duration of 8 mo (range 3-20 mo). Among these, 15 patients were successfully managed with per-anal dilatation. On multivariate analysis, advance age (> 60 years) was the only risk factor for anastomotic leak (P = 0.004). On the other hand, anastomotic leak (P = 0.00), mucin positive tumor (P = 0.021), and lower rectal growth (P = 0.011) were found as risk factors for the development of an anastomotic stricture.
  
  
  CONCLUSIONS
  Advance age is a risk factor for an anastomotic leak. An anastomotic leak, a mucin-secreting tumor, and lower rectal growth predispose patients to develop anastomotic strictures.
authors.affiliation: Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India. dr_ashokgupta@yahoo.com
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Ram
authors.initials: R
authors.lastname: Daga
authors.forename: Paari
authors.initials: P
authors.lastname: Vijayaragavan
authors.forename: Anand
authors.initials: A
authors.lastname: Prakash
authors.forename: Rajneesh Kumar
authors.initials: RK
authors.lastname: Singh
authors.forename: Anu
authors.initials: A
authors.lastname: Behari
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Kapoor
authors.forename: Rajan
authors.initials: R
authors.lastname: Saxena
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology* / Q000601:surgery; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007194:India; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects*; D013536:Suture Techniques / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult