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COMPLICATIONS
AFTER RECTAL CANCER SURGERY
Saladzinskas
Z, Pavalkis D, Tamelis A, Rudinskaite G.
Unit
of Coloproctology, Dept. of Surgery, Kaunas Medical University
Hospital, Kaunas, Lithuania
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ABSTRACT
Aim
of the study was to evaluate frequency of anastomotic leakage (AL)
after rectum and sigmoid cancer surgery and their risk factors (patient'
age, sex, preoperative condition, tumor stage, preoperative radiotherapy,
preoperative complications, multivisceral resections, tumor and
anastomosis height, quality of resection, anastomotic techniques
and protective ileostomy). A retrospective analysis of patients,
who underwent rectum or sigmoid resections for cancer at Kaunas
Medical University hospital (KMUH) between the years 1995 January
and 2001 June, was reviewed. Two hundred sixty nine primary resections
were performed: 166 - rectal and 103 sigmoid. AL occurred in 20
patients (7.4%): in 9% (15 patients) of 166 rectum resections for
cancer with primary anastomosis: 23.8% after proctectomy and coloanal
anastomosis (PCA) (for five patients), 10.3% after low anterior
resection (LAR) (for eight patients), 3% after high anterior resection
(HAR) (for two patients), and after 103 sigmoid resections (SR)
- 4.9 % (for five patients). Multivariate analysis of overall population
showed that independent factors for the development of anastomotic
leakage were male sex and anastomotic height from anal verge. Risk
of AL was 3.9 times higher for men than for women (P = 0.02), and
3.5 times higher for low anastomosis (at or below 10 cm from the
anal verge) (P = 0.01). Analysis of low colorectal and coloanal
anastomosis (n = 99) showed that only male sex is significant prognostic
factor of AL. Multivariate analysis of group of patients after rectum
and sigmoid resections with anastomosis higher than 10 cm from the
anal verge (n = 170) showed that preoperative patient's condition
(ASA) is significant factor for the development of AL. Risk factors
for anastomotic leakage are low rectal anastomosis, especially in
male and in generally unfit patients. These conditions suggest creation
of temporary protective ileostomy in high-risk patients groups.
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Keywords:
Colorectal cancer, Surgery, Complications |
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