Publication:


abstract

OBJECTIVE:

the objective of this study is to identify rates and factors associated with permanent diversion following restorative proctosigmoidectomy for rectal cancer when complicated by an Anastomotic leak.

DESIGN:

This study is a retrospective review.

SETTING:

The setting of this study is a tertiary referral hospital

PATIENTS:

Patients involved in this study were those who underwent restorative rectal cancer surgery from 1997 through 2008 identified from an institutional cancer database.

INTERVENTIONS:

No interventions were performed in this study.

MAIN OUTCOME MEASURES:

Factors associated with time to ostomy closure and rates of permanent diversion following anastomotic leaks

RESULTS:

One hundred and thirty patients (mean age 59.7 years) were identified, 111 (85%) of whom had stoma diversion at the index surgery. Asymptomatic occult radiological leaks occurred in 52 patients (40%). Seventy-eight patients (60%) underwent ultimate ostomy closure at a median time of 6.3 months after the index surgery, which was not significantly affected by previous radiotherapy (p = 0.08). Twelve patients (9%) underwent anastomotic reconstruction. Pathologic stage II or greater (OR 4.42; 1.95-10.04), symptomatic presentation (OR 4.13; 1.86-9.19) and anastomotic disruption >5 mm (OR 4.42; 2.01-9.74) were independently associated with permanent diversion. Among all survivors, 33% did not have their ostomy reversed. Stoma diversion constructed after leak detection in 19 patients (15%) did not affect permanent stoma rate (OR 0.86; 0.31-2.34) or time to stoma closure (p = 0.29).

CONCLUSIONS:

The majority of anastomotic leaks after restorative rectal cancer surgery can be salvaged without anastomotic reconstruction. However, in one third of the patients, an anastomotic leak results in a permanent stoma.

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