Standardized pelvic drainage of anastomotic leaks following anterior resection without diversional stomas

Peng, Junjie; Lu, Jiade; Xu, Ye; Guan, Zuqing; Wang, Minghe; Cai, Guoxiang; Cai, Sanjun

doi:10.1016/j.amjsurg.2009.03.026

« Previous Next »The American Journal of Surgery
Volume 199, Issue 6 , Pages 753-758, June 2010

Standardized pelvic drainage of anastomotic leaks following anterior resection without diversional stomas

Junjie Peng, M.D.
- Department of Colorectal Surgery, Cancer Hospital of Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Jiade Lu, M.D.
- Department of Radiation Oncology, National University Hospital, Singapore, Singapore
Ye Xu, M.D.
- Department of Colorectal Surgery, Cancer Hospital of Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Zuqing Guan, M.D.
- Department of Colorectal Surgery, Cancer Hospital of Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Minghe Wang, M.D.
- Department of Colorectal Surgery, Cancer Hospital of Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Guoxiang Cai, M.D.
- Department of Colorectal Surgery, Cancer Hospital of Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Sanjun Cai, M.D.
- Department of Colorectal Surgery, Cancer Hospital of Fudan University, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Corresponding author: Tel.: 86-21-64175590; fax: 86-21-64035387

Received 28 October 2008; received in revised form 14 March 2009 published online 19 October 2009.

Abstract

Background

Anastomotic leakage is a serious complication in rectal cancer surgery. More than one third of rectal cancer patients with low anterior resection (LAR) will receive defunctional stomas during primary operation.

Methods

Six hundred thirty-nine consecutive rectal cancer patients, whose tumors were located 5 to 12 cm from the anal verge, were treated with LAR. A standardized pelvic drainage for all these patients and selective irrigation for patients with leakage were conducted, and defunctional stoma was used as a salvage modality. All the anastomoses were all extraperitonealized during primary operations.

Results

The anastomotic leakage rate was 7.04%. Male gender and location of tumor were found to be risk factors for leakage in patients with LAR. The overall stoma rate was 1.88%. Nearly 75% of leakage could be cured by irrigation-suction without surgical intervention. Severe complications, such as peritonitis, fistula, and obstruction, were strong predictors of irrigation failure.

Conclusions

Extraperitonealized anastomosis and pelvic drainage obtained a very low rate of defunctional stoma for LAR. Pelvic irrigation-suction was an effective modality to resolve anastomotic leakage.

Keywords: Rectal cancer, Low anterior resection, Anastomotic leakage, Pelvic drainage, Defunctional stoma