High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage.
BACKGROUND
It is controversial whether division of the inferior mesenteric artery close to the aorta influences the risk of anastomotic leakage, especially in the elderly and unfit. This population-based study was carried out to evaluate the independent association between a high arterial ligation and anastomotic leakage in anterior resection for rectal cancer.


METHODS
All patients who had anterior resection for rectal cancer from 2007 to 2009 inclusive were identified in the Swedish Colorectal Cancer Registry. The association between high tie and anastomotic leakage was evaluated in a logistic regression model, with adjustment for confounders. Stratification was performed for co-morbidity as judged by the American Society of Anesthesiologists (ASA) classification.


RESULTS
Symptomatic anastomotic leakage occurred in 81 (9·9 per cent) of 818 patients with a high tie and 108 (9·8 per cent) of 1101 without. Overall, the use of a high tie was not associated with a higher risk of anastomotic leakage (odds ratio (OR) 1·00, 95 per cent confidence interval 0·72 to 1·39). There was no increased risk in patients classifed as ASA grade I or II (OR 0·97, 0·69 to 1·35), or in those graded ASA III or IV (OR 1·26, 0·58 to 2·75).


CONCLUSIONS
In the present population-based setting, use of a high tie was not associated with an increased rate of symptomatic anastomotic leakage.
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. martin.rutegard@ki.se
M
M
Rutegård
O
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Hemmingsson
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Matthiessen
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J
Rutegård
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012042:Registries; D013548:Sweden / Q000453:epidemiology