Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer

Nelson, R. Scott; Boland, Elena; Ewing, B. Mark; Blatchford, Garnet J.; Ternent, Charles; Shashidharan, M.; Tran, N. Anh; Beaty, Jennifer; Thorson, Alan G.

doi:10.1016/j.amjsurg.2009.05.024

« Previous Next »The American Journal of Surgery
Volume 198, Issue 6 , Pages 765-770, December 2009

Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer

R. Scott Nelson, D.O.
- Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA
Elena Boland, M.D.
- Department of Surgery; University of Nebraska Medical Center, Omaha, NE, USA
B. Mark Ewing, M.S.
- Department of Mathematics, Brigham Young University, Provo, UT, USA
Garnet J. Blatchford, M.D.
- Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA
Charles Ternent, M.D.
- Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA
M. Shashidharan, M.D.
- Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA
N. Anh Tran, M.D.
- Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA
Jennifer Beaty, M.D.
- Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA
Alan G. Thorson, M.D.
- Colon and Rectal Surgery, Creighton University Medical Center, Omaha, NE, USA
- Corresponding author. Tel.: +1-402-343-1122; fax: +1-402-343-1177

Received 10 March 2009; received in revised form 27 May 2009

Abstract

Background

The aim of this study was to assess the rate of permanent diversion in patients undergoing coloanal anastomosis after neoadjuvant therapy for rectal cancer.

Methods

We performed a retrospective review of patients with rectal cancer who underwent a total mesorectal excision of a tumor within 9 cm of the anal verge.

Results

There were 201 patients who underwent resection with coloanal anastomosis, with a mean follow-up period of 51 months. The average tumor distance from the anal verge was 7 cm (range, 4–9 cm). Neoadjuvant therapy was administrated in 145 patients, 47 had no radiation, and 9 received radiation postoperatively. Thirty-two patients (16%) had long-term complications including incontinence, fistulas, and strictures. Twenty-five patients (12%) had recurrent disease, 16 of these were local recurrence. The total rate of permanent diversion was 29 (14%). Reasons for diversion included local recurrence in 12 patients (6%), complications in 10 patients (5%), and poor function in 7 patients (3%).

Conclusions

Poor bowel function, late complications, and local recurrence all contribute to permanent diversion after a coloanal anastomosis. Neoadjuvant therapy in conjunction with a total mesorectal excision and coloanal anastomosis leads to acceptably low permanent diversion rates in the vast majority of patients.

Keywords: Coloanal anastomosis, Rectal cancer, Permanent diversion, Neoadjuvant radiotherapy