Risk factors for anastomotic failure after TME surgery for rectal cancer

Background: Anastomotic leakage is a major complication after rectal cancer surgery. We investigated risk factors that were associated with symptomatic anastomotic leakage after total mesorectal excision. Method: Between 1996 and 1999 patients with operable rectal cancer were randomised between short-term radiotherapy followed by TME and TME alone. Eligible Dutch patients who underwent an anterior resection (n = 924) were retrospectivally studied. Results: Leakage occurred in 107 patients (11.8%). Pelvic drainage and the use of a protective stoma were signifi cantly associated with decreased anastomotic failure rates. A signifi cant correlation between the absence of a stoma and anastomotic dehiscence was present in both male and female patients, and not only for distal, but also for proximal rectal tumours. In case of anastomotic failure, the presence of pelvic drains and a covering stoma were both related to a reduction in leaks requiring surgical reintervention. Conclusion: It is recommendable to place one or more pelvic drains after TME to limit the consequences of anastomotic failure. A covering stoma is signifi cantly associated with decreased anastomotic dehiscence and re-intervention rates in patients with both low and high rectal tumours, regardless their gender. The decision to construct a temporary stoma may be supported by this study. Risk factors for anastomotic failure after TME surgery for rectal cancer 87