title: Anastomotic leakage and presacral abscess formation after locally advanced rectal cancer surgery: Incidence, risk factors and treatment.
abstract: OBJECTIVE
  Anastomotic leakage (AL) and presacral abscess (PA) after rectal cancer surgery are a major concern for the colorectal surgeon. In this study, incidence, prognosis and treatment was assessed.
  
  
  METHODS
  Patients operated on in our institute, between 1994 and 2011, for locally advanced rectal cancer (LARC, T3+/T4M0) were included. Morbidity was scored using the Clavien-Dindo classification. Prognostic factors were analysed using binary logistic regression.
  
  
  RESULTS
  517 patients were included after a low anterior resection (n = 219) or abdominoperineal resection (n = 232). AL occurred in 25 patients (11.4%); 50 patients (9.7%) developed a PA. We identified intraoperative blood loss ≥4500 cc (p = 0.038) and the era of surgery; patients operated on before the year 2006 (p = 0.042); as risk factors for AL. The time between last day of neo-adjuvant treatment and surgery, <8 weeks is significantly associated with the development of PA (p = 0.010).
  
  
  CONCLUSIONS
  In our population of LARC patients we found an incidence of 9.7% PA and 11.4% AL, with a 12% mortality rate for AL, which is comparable to surgery in general colorectal cancer. Increased intraoperative blood loss and surgery prior to 2006 are associated with AL. Increased intraoperative blood loss and a timing interval <8 weeks increases the risk of PA formation.
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Thomas.vermeer@catharinaziekenhuis.nl.
authors.forename: T A
authors.initials: TA
authors.lastname: Vermeer
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Ricardo.orsini@catharinaziekenhuis.nl.
authors.forename: R G
authors.initials: RG
authors.lastname: Orsini
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Freek.daams@catharinaziekenhuis.nl.
authors.forename: F
authors.initials: F
authors.lastname: Daams
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Grard.nieuwenhuijzen@catharinaziekenhuis.nl.
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. Electronic address: Harm.rutten@catharinaziekenhuis.nl.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
mesh_terms: D000038:Abscess / Q000453:epidemiology* / Q000628:therapy; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000453:epidemiology* / Q000628:therapy; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015331:Cohort Studies; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D020360:Neoadjuvant Therapy / Q000706:statistics & numerical data; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012445:Sacrococcygeal Region; D013997:Time Factors
keywords: Anastomotic leakage; Locally advanced rectal cancer; Presacral abscess; Treatment