To Drain or Not to Drain Infraperitoneal Anastomosis After Rectal Excision for Cancer

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

To assess the effect of pelvic drainage after rectal surgery for cancer.

Related collections

Most cited references 21

Record: found
Abstract: found
Article: not found

Risk factors for anastomotic leakage after anterior resection of the rectum.

O Hallböök, P Matthiessen, R Sjödahl … (2004)

Surgical technique and peri-operative management of rectal carcinoma have developed substantially in the last decades. Despite this, morbidity and mortality after anterior resection of the rectum are still important problems. The aim of this study was to identify risk factors for anastomotic leakage in anterior resection and to assess the role of a temporary stoma and the need for urgent re-operations in relation to anastomotic leakage. In a nine-year period, from 1987 to 1995, a total of 6833 patients underwent elective anterior resection of the rectum in Sweden. A random sample of 432 of these patients was analysed (sample size 6.3%). The associations between death and 10 patient- and surgery-related variables were studied by univariate and multivariate analysis. Data were obtained by review of the hospital files from all patients. The incidence of symptomatic clinically evident anastomotic leakage was 12% (53/432). The 30-day mortality was 2.1% (140/6833). The rate of mortality associated with leakage was 7.5%. A temporary stoma was initially fashioned in 17% (72/432) of the patients, and 15% (11/72) with a temporary stoma had a clinical leakage, compared with 12% (42/360) without a temporary stoma, not significant. Multivariate analysis showed that low anastomosis (< or = 6 cm), pre-operative radiation, presence of intra-operative adverse events and male gender were independent risk factors for leakage. The risk for permanent stoma after leakage was 25%. Females with stoma leaked in 3% compared to men with stoma who leaked in 29%. The median hospital stay for patients without leakage was 10 days (range 5-61 days) and for patients with leakage 22 days (3-110 days). In this population based study, 12% of the patients had symptomatic anastomotic leakage after anterior resection of the rectum. Postoperative 30-day mortality was 2.1%. Low anastomosis, pre-operative radiation, presence of intra-operative adverse events and male gender were independent risk factors for symptomatic anastomotic leakage in the multivariate analysis. There was no difference in the use of temporary stoma in patients with or without anastomotic leakage.

0 comments Cited 109 times – based on 0 reviews      Review now

Record: found
Abstract: not found
Article: not found

Rectal Cancer

Richard Heald, Roger D. H. Ryall, John K MacFarlane … (1998)

0 comments Cited 73 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients.

M T Eriksen, A Wibe, J Norstein … (2005)

Mesorectal excision is successfully implemented as the standard surgical technique for rectal cancer resections in Norway. This technique has been associated with higher rates of anastomotic leakage (AL) and the purpose of this study was to examine AL in a large national cohort of patients. This was a prospective national cohort study of 1958 patients undergoing rectal cancer surgery with anterior resection in Norway from November 1993 to December 1999. The overall rate of AL was 11.6% (228 of 1958 patients). In a multivariate analysis, the risk of AL was significantly higher in males (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1-2.2), in patients receiving pre-operative radiotherapy (OR 2.2, CI 1.0-4.7) and in low level (4-6 cm) (OR 3.5, CI 1.6-7.7) and ultra-low level (< or = 3 cm) anastomoses (OR 5.4, CI 2.3-12.9). The presence of a diverting stoma was associated with a 60% reduction in the risk of AL (OR 0.4, CI 0.3-0.7) for anastomoses 6 cm and below. 30-day mortality was significantly higher for the patients with AL (7.0%, CI 3.7-10.3) compared with no AL (2.4%, CI 1.7-3.2) AL had no significant effect on local recurrence rate (log rank P=0.608). Low anastomoses should be defunctioned to avoid AL and the associated high perioperative mortality. No effect of AL on local recurrence was found in this large cohort.

0 comments Cited 69 times – based on 0 reviews      Review now

All references

Author and article information

Journal

Title: Annals of Surgery

Abbreviated Title: Annals of Surgery

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 0003-4932

Publication date Created: 2017

Publication date (Print): March 2017

Volume: 265

Issue: 3

Pages: 474-480

Article

DOI: 10.1097/SLA.0000000000001991

PubMed ID: 27631776

SO-VID: 3066244f-579f-407a-a7a9-95b04e9de693

History

Data availability:

Comments

Comment on this article

Cited by 53

See all cited by

Most referenced authors 455

See all reference authors

- Version 1

To Drain or Not to Drain Infraperitoneal Anastomosis After Rectal Excision for Cancer : The GRECCAR 5 Randomized Trial

Read this article at