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.
Similar content being viewed by others
References
Vignali A, Fazio VW, Lavery IC et al (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185(2):105–113
Phitayakorn R, Delaney CP, Reynolds HL et al (2008) Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg 32(6):1147–1156
Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD (2010) Postoperative complications following surgery for rectal cancer. Ann Surg 251(5):807–818
Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23(3):265–270
Makela JT, Kiviniemi H, Laitinen S (2003) Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 46(5):653–660
Ptok H, Marusch F, Meyer F et al (2007) Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 94(12):1548–1554
den Dulk M, Marijnen CA, Collette L et al (2009) Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 96(9):1066–1075
Eberhardt JM, Kiran RP, Lavery IC (2009) The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum 52(3):380–386
Bailey CM, Wheeler JM, Birks M, Farouk R (2003) The incidence and causes of permanent stoma after anterior resection. Colorectal Dis 5(4):331–334
Mala T, Nesbakken A (2008) Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 10(8):785–788
Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6(6):462–469
Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246(2):207–214
Remzi FH, Fazio VW, Gorgun E et al (2005) Quality of life, functional outcome, and complications of coloplasty pouch after low anterior resection. Dis Colon Rectum 48(4):735–743
Maggiori L, Bretagnol F, Lefevre JH, Ferron M, Vicaut E, Panis Y (2011) Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 13:632–637
Lindgren R, Hallböök O, Rutegård J, Sjödahl R, Matthiessen P (2011) What is the risk for a permanent stoma after low anterior resection for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum 54(1):41–47
den Dulk M, Smit M, Peeters KC et al (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8(4):297–303
Lefebure B, Tuech J, Bridoux V et al (2008) Evaluation of selective defunctioning stoma after low anterior resection for rectal cancer. Int J Colorectal Dis 23(3):283–288
Kirat H, Remzi F, Shen B, Kiran R (2011) Pelvic abscess associated with anastomotic leak in patients with ileal pouch-anal anastomosis (IPAA): transanastomotic or CT-guided drainage? Int J Colorectal Dis 26:1469–1474
Author information
Authors and Affiliations
Corresponding author
Additional information
Poster presentation at the American Society of Colon and Rectal Surgeons, Minneapolis, MN, May 15–19, 2010.
The authors have no relevant financial disclosures.
Rights and permissions
About this article
Cite this article
Ogilvie, J.W., Dietz, D.W. & Stocchi, L. Anastomotic leak after restorative proctosigmoidectomy for cancer: what are the chances of a permanent ostomy?. Int J Colorectal Dis 27, 1259–1266 (2012). https://doi.org/10.1007/s00384-012-1423-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-012-1423-9