title: Rarity of late anastomotic leakage after low anterior resection of the rectum.
abstract: BACKGROUND
  Late anastomotic leakage is reported to account for half of all anastomotic leakages after low anterior resection of the rectum. An important clinical question is whether late and early anastomotic leakages are different entities.
  
  
  METHODS
  We retrospectively reviewed the medical records of patients who experienced anastomotic leakage after low anterior resection in two Japanese hospitals. The clinical characteristics were extracted and analyzed.
  
  
  RESULTS
  During the study period, 179 patients underwent low anterior resection. A pelvic drainage tube was routinely utilized in all cases and was generally removed 4 to 6 days after the operation. Twenty-six patients had anastomotic leakage; the diagnosis was based on fecal contamination of the drainage in 24 cases. The median interval between operation and detection of anastomotic leakage was 3.5 days. Anastomotic leakage was diagnosed within 7 days of the operation in 25 cases and on postoperative day 20 (after hospital discharge) in one case. There was no instance of anastomotic leakage diagnosed more than 30 days after the operation. There was no relationship between clinical variables and days of leakage diagnosis.
  
  
  CONCLUSIONS
  The rarity of late anastomotic leakage in our study, compared with previous studies, may relate to the relatively extended period of pelvic drainage tube usage in our institutes, which likely shortens the interval before leakage diagnosis. Our results suggest that late anastomotic leakage is a delayed symptom of subtle early anastomotic leakage rather than a separate entity.
authors: Cancer Treatment Center, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku-city, Kochi, 783-8505, Japan, hmaeda@kochi-u.ac.jp.
authors: Hiromichi
authors: H
authors: Maeda
authors: Ken
authors: K
authors: Okamoto
authors: Tsutomu
authors: T
authors: Namikawa
authors: Toyokazu
authors: T
authors: Akimori
authors: Norihito
authors: N
authors: Kamioka
authors: Mai
authors: M
authors: Shiga
authors: Ken
authors: K
authors: Dabanaka
authors: Kazuhiro
authors: K
authors: Hanazaki
authors: Michiya
authors: M
authors: Kobayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012004:Rectal Neoplasms / Q000601:surgery; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors