ANASTOMOTIC LEAK AFTER DOUBLE-STAPLED LOW COLORECTAL RESECTION - AN ANALYSIS OF RISK-FACTORS

PURPOSE: Anastomotic leaks after double-stapled low anterior resection were associated with a number of factors related to patient condition , level of anastomosis, and variety of surgery-related and antitumor t herapy-related factors. This retrospective analysis of a group of pati ents with consistent length of rectal stump was undertaken to determin e the risk factors of anastomotic leak after low colorectal resection related to surgery and to intraperitoneal chemotherapy. METHODS: A gro up of 165 patients treated with surgery only, surgery with early posto perative intraperitoneal chemotherapy, and surgery with hyperthermic i ntraoperative and early postoperative intraperitoneal chemotherapy. Al l patients underwent surgery that used the double-stapled technique wi th transection of the rectum through its middle third. In univariate a nd multivariate analysis, the relationship between anastomotic leak ra te and extent of colon resection, length of residual colon, presence o f left colon, and type of applied treatment was studied. RESULTS: With a full length of residual colon, leak rate was 1 percent but increase d progressively with the extent of proximal colon resection. Removal o f the left colon was associated with the 2.7 odds ratio for anastomoti c disruption. Leak rate after surgery only was 6 percent; surgery with normothermic intraperitoneal chemotherapy was 5 percent; and surgery with heated intraperitoneal chemotherapy was 20 percent. CONCLUSIONS: In this group of patients with consistent length of residual rectum, t he incidence of anastomotic disruption was related to extent of proxim al colon resection. Anastomotic integrity was not compromised by normo thermic intraperitoneal chemotherapy. Hyperthermic intraperitoneal che motherapy was associated with high leak rate only when extensive resec tion of the colon was performed. Variables other than extent of rectal excision are important in causing a leak of colorectal anastomosis.