Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer.
OBJECTIVE
This study aimed to determine the clinical outcome of salvage surgery without restoring continuity for symptomatic chronic presacral sinus after low anterior resection (LAR) for rectal cancer.


METHODS
Out of a prospective cohort of 46 patients with chronic presacral sinus (> 1 year after LAR), 27 underwent completion proctectomy with omentoplasty between January 2005 and July 2014.


RESULTS
The initial treatment for rectal cancer included neoadjuvant radiotherapy in 26 (96%) patients. Besides a chronic presacral sinus, a secondary fistula was present in 15 (56%) patients. Definitive salvage surgery was performed after a median of 40 (12-350) months from the primary resection. The median hospital stay after single- and multiple-stage salvage surgery was 11 and 17 days. Postoperative complications occurred in 44% of patients. The re-intervention rate was 33% with a range of 1-10 interventions per patient. During a median follow-up of 20 (4-45) months from salvage surgery, healing of the chronic presacral sinus occurred in 78% of patients, with a healing rate after single- and multiple-stage procedures of 88% and 64% respectively (P = 0.19).


CONCLUSIONS
Patients with a symptomatic chronic presacral sinus after LAR for rectal cancer, in whom restoration of continuity is not intended, can be effectively managed by completion proctectomy with complete debridement of the sinus and fistula tracts followed by an omentoplasty to fill the presacral cavity, preferably as a single-stage procedure.
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
G D
GD
Musters
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
W A
WA
Borstlap
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
W A
WA
Bemelman
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
C J
CJ
Buskens
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
P J
PJ
Tanis
D000368:Aged; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002908:Chronic Disease; D003082:Colectomy / Q000009:adverse effects; D017577:Cutaneous Fistula / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012445:Sacrococcygeal Region; D016879:Salvage Therapy; D019738:Surgically-Created Structures; D016896:Treatment Outcome
Chronic presacral sinus; intersphincteric completion proctectomy; omental plasty; rectal cancer; salvage surgery