title: Low colorectal anastomosis after pelvic exenteration for gynecologic malignancies: risk factors analysis for leakage.
abstract: OBJECTIVE
  To study risk factors for low colorectal anastomotic leak after pelvic exenteration for gynecologic malignancies.
  
  
  METHODS
  Data from 60 patients, 32 with ovarian cancer and 28 with nonovarian cancer who underwent pelvic exenteration with colorectal anastomosis (CRA) were retrospectively analyzed.
  
  
  RESULTS
  Overall rate of CRA leak was 20%. The CRA leak was associated with type of tumor (3% for the ovarian cancer and 40.8% for the nonovarian cancer, P = 0.004), CRA height (<5 cm vs ≥5 cm, 75% vs 6.3%; P = 0.001), and previous radiotherapy (RT; 53.3% vs 8.9%; P = 0.001). Multivariate analysis showed that only previous RT and CRA height were associated with the CRA leak. Rectosigmoid wall involvement (81.8% vs 27%; P = 0.001) and mesorectum infiltration (69.2% vs 21.7%; P = 0.001) were more frequent among patients with ovarian cancer patients.
  
  
  CONCLUSIONS
  Previous RT and CRA at or less than 5 cm from the anal verge pose a high risk for CRA leak. In these cases, a definitive colostomy should be recommended.
authors.affiliation: Department of Gynecology Division, Clínica Universitaria, University of Navarra, School of Medicine, Pamplona, Spain. mjurado@unav.es
authors.forename: Matías
authors.initials: M
authors.lastname: Jurado
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcazar
authors.forename: Jorge
authors.initials: J
authors.lastname: Baixauli
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Hernandez-Lizoain
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology*; D003106:Colon / Q000601:surgery*; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D010385:Pelvic Exenteration / Q000009:adverse effects*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors