title: High complication rate after low anterior resection for mid and high rectal cancer; results of a population-based study.
abstract: BACKGROUND
  Surgical resection is the cornerstone of treatment for rectal cancer patients. Treatment options consist of a primary anastomosis, anastomosis with defunctioning stoma or end-colostomy with closure of the distal rectal stump. This study aimed to compare postoperative outcome of these three surgical options.
  
  
  METHODS
  Data was derived from the national database of the Dutch Surgical Colorectal Audit. Mid and high rectal cancer patients who underwent rectal cancer resection between January 2011 and December 2012 were included. Endpoints were postoperative complications including anastomotic leakage, reinterventions, hospital stay and mortality within 30 days postoperative.
  
  
  RESULTS
  In total, 2585 patients were included. Twenty-five per cent of all patients received a primary anastomosis; 51% an anastomosis with defunctioning stoma, and 24% an end-colostomy. More than one third of patients developed postoperative complications, the lowest rate being in the primary anastomosis group. Anastomotic leakage rates were 12% in patients with a primary anastomosis, and 9% in patients with an anastomosis with defunctioning stoma (p < 0.05). Multivariate analysis showed more postoperative complications, prolonged hospital stay, and increased mortality rates in patients with a defunctioning stoma or end-colostomy. The latter had proportionally less invasive reinterventions when compared to the other two groups.
  
  
  CONCLUSIONS
  Patients with a primary anastomosis had the best postoperative outcome. A defunctioning stoma leads to a lower anastomotic leakage rate, though is associated with higher rates of complications, prolonged hospital stay and mortality. The decision to create a defunctioning stoma should be focus of future studies.
authors.affiliation: University Medical Center Groningen, Department of Abdominal Surgery, University of Groningen, Groningen, The Netherlands. Electronic address: ilsalienbakker@gmail.com.
authors.forename: I S
authors.initials: IS
authors.lastname: Bakker
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: H S
authors.initials: HS
authors.lastname: Snijders
authors.affiliation: Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Amsterdam, The Netherlands.
authors.forename: M W
authors.initials: MW
authors.lastname: Wouters
authors.affiliation: University Medical Center Groningen, Department of Abdominal Surgery, University of Groningen, Groningen, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Havenga
authors.affiliation: Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands.
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.affiliation: University Medical Center Groningen, Department of Abdominal Surgery, University of Groningen, Groningen, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Wiggers
authors.affiliation: Reinier de Graaf Hospital, Department of Surgery, Delft, The Netherlands.
authors.forename: J W T
authors.initials: JW
authors.lastname: Dekker
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003125:Colostomy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Low anterior resection; Malignancy; National audit; Postoperative complications; Rectal cancer; Surgical outcome