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Selective treatment of rectal cancer with single-stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

The surgical treatment of low rectal cancer commonly includes low pelvic anastomoses with coloanal or ultralow colorectal anastomoses. Anastomotic leak rates in low pelvic anastomoses range from 4 to 26%. Many surgeons opt to routinely create a diverting ostomy to reduce the extent of morbidity should an anastomotic leak occur. The intent of our study was to determine if our policy of selected diversion is safe.

Materials and methods

A retrospective chart review of 66 rectal cancer patients who underwent proctectomy and low pelvic anastomoses—less than 6 cm from anal verge, with or without a diverting ostomy—was undertaken. Temporary diverting stomas were utilized at the discretion of the attending surgeon primarily based on subjective criteria. The main outcome was postoperative complications.

Results/findings

Forty-nine patients (78% preoperatively irradiated) were treated with a one-stage operation, whereas 17 (53% preoperatively irradiated) underwent reconstruction with proximal diversion. The mean anastomotic height for patients with a single stage procedure was 3.8 cm above the anal verge versus 2.6 for patients with a two-stage procedure (p = 0.076). Complication rates were lower in patients who did not undergo diversion (29% vs 47%, p = 16). With regard to anastomotic-associated complications for single stage versus two stage, complication rates were 8% versus 18%, respectively (p = 0.27).

Interpretation/conclusion

Low pelvic anastomoses in rectal cancer patients can be safely performed as a single-stage procedure, reserving the use of diversion for select cases.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, University of California, Irvine Medical Center, Irvine, CA, USA

    Allen P. Kong, Sejal M. Udani & Michael J. Stamos

  2. Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, 1000 W Carson Street, Box 25, Torrance, CA, 90509, USA

    Justin Kim, Alicia Holt, Viken Konyalian, Richard Huynh & Ravin R. Kumar

Authors
  1. Allen P. Kong
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  2. Justin Kim
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  3. Alicia Holt
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  4. Viken Konyalian
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  5. Richard Huynh
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  6. Sejal M. Udani
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  7. Michael J. Stamos
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  8. Ravin R. Kumar
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Corresponding author

Correspondence to Ravin R. Kumar.

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Kong, A.P., Kim, J., Holt, A. et al. Selective treatment of rectal cancer with single-stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality. Int J Colorectal Dis 22, 897–901 (2007). https://doi.org/10.1007/s00384-007-0274-2

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  • DOI: https://doi.org/10.1007/s00384-007-0274-2

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