title: High 1-year complication rate after anterior resection for rectal cancer.
abstract: BACKGROUND
  Surgical options after anterior resection for rectal cancer include a primary anastomosis, anastomosis with a defunctioning stoma, and an end colostomy. This study describes short-term and 1-year outcomes of these different surgical strategies.
  
  
  METHODS
  Patients undergoing surgical resection for primary mid and high rectal cancer were retrospectively studied in seven Dutch hospitals with 1-year follow-up. Short-term endpoints were postoperative complications, re-interventions, prolonged hospital stay, and mortality. One-year endpoints were unplanned readmissions and re-interventions, presence of stoma, and mortality.
  
  
  RESULTS
  Nineteen percent of 388 included patients received a primary anastomosis, 55% an anastomosis with defunctioning stoma, and 27% an end colostomy. Short-term anastomotic leakage was 10% in patients with a primary anastomosis vs. 7% with a defunctioning stoma (P = 0.46). An end colostomy was associated with less severe re-interventions. One-year outcomes showed low morbidity and mortality rates in patients with an anastomosis. Patients with a defunctioning stoma had high (18%) readmissions and re-intervention (12%) rates, mostly due to anastomotic leakage. An end colostomy was associated with unplanned re-interventions due to stoma/abscess problems. During follow-up, there was a 30% increase in patients with an end colostomy.
  
  
  CONCLUSIONS
  This study showed a high 1-year morbidity rate after anterior resection for rectal cancer. A defunctioning stoma was associated with a high risk for late complications including anastomotic leakage. An end colostomy is a safe alternative to prevent anastomotic leakage, but stomal problems cannot be ignored. Selecting low-risk patients for an anastomosis may lead to favorable short- and 1-year outcomes.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300, RC, Leiden, The Netherlands, h.s.snijders@lumc.nl.
authors.forename: H S
authors.initials: HS
authors.lastname: Snijders
authors.forename: I S
authors.initials: IS
authors.lastname: Bakker
authors.forename: J W T
authors.initials: JW
authors.lastname: Dekker
authors.forename: T A
authors.initials: TA
authors.lastname: Vermeer
authors.forename: E C J
authors.initials: EC
authors.lastname: Consten
authors.forename: C
authors.initials: C
authors.lastname: Hoff
authors.forename: J M
authors.initials: JM
authors.lastname: Klaase
authors.forename: K
authors.initials: K
authors.lastname: Havenga
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: T
authors.initials: T
authors.lastname: Wiggers
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology*; D003106:Colon / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors