|
Over 14 years 276 patients with rectal cancer underwent
surgery; 219 who underwent low anterior resection of the rectum with total mesorectal
excision were studied. There were 24 (11.0 percent) major anastomotic leaks
associated with peritonitis or a pelvic collection and 14 (6.4 percent) minor leaks that
were asymptomatic and detected by contract enema. All major leaks occurred at an
anastomotic height of less than 6cm (P=0.08). The abdominoperineal excision rate was
9.1 percent. Major leaks were associated with failure to defunction in 11 of 62
patients and with a defunctioning colostomy in 13 of 157 (P=0.03). Of the 24
patients with major leaks seven developed peritonitis, one with a defunctioned anastomosis
(P=0.002), and three died (P=0.02). Use of the sigmoid colon led to major leakage in
seven of 32 patients compared with 17 of 187 when the splenic flexure was employed
(P=0.05). There was no increase in the local recurrence rate but only nine patients
with major leakage and a temporary stoma have had these closed. Key technical
factors include: a clean dry pelvic cavity, pulsatile colonic blood supply, suction
drainage started during closure and mobilization of ample tissue to fill the pelvic space. |
