Abstract
Purpose: The aim of this study was to evaluate the parameters related to septic complications after curative surgery for rectal cancer. Patients and Methods: Eighty-two patients treated in our clinic with the diagnosis of stage II and III rectal carcinoma have been evaluated retrospectively. The parameters evaluated were age, gender, tumor localisation (lower, mid, upper rectum), the type of surgery (low anterior resection, abdominoperineal resection), the presence of radical abdominopelvic lymph node dissection, emergency or elective surgery, hand sewn or stapled anastomosis, diverting ileostomi or colostomy, peroperative blood transfusion, stage, preoperative albumin and hemoglobin measurements. Results: The type of surgery was low anterior resection for 42 patients and abdominoperineal resection for 40 patients. Septic complications were seen in 26 (31%) patients. Twelve (14%) of them were anastomotic leak and 14 were pelvic abscess. In univariate analysis, low anterior resection, emergency surgery, preoperative low albumin and hemoglobin levels (≤3gr /dL and ≤11 gr/dL, respectively) were found to increase pelvic septic complications. In multivariate analysis, low anterior resection and low albumin levels were found to be related to pelvic septic complications. Conclusion: Low rectal anastomosis is a significant risk factor for complications. Preoperative treatment of hypoalbuminemia and anemia and preference of elective surgery are important for this group of patients.
Keywords:
Rectum carcinoma, septic complications
References
1
F. Charles Brunicardi. Schwartz’s Principles of Surgery. Eighth edition. McGraw-Hill Medical Publishing Division 2005; 1066-1075.
2
Palmer G, Martling A, Cedermark B, et al. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 2007;14:447-454.
3
Alvarez JA, Baldonedo RF, Bear IG, et al. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005;190:376-382.
4
Tøttrup A, Frost L. Pelvic sepsis after extended Hartmann’s procedure. Dis Colon Rectum 2005;48:251-255.
5
Kollmorgen CF, Meagher AP, Wolff BG, et al. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994;220:676-682.
6
Dahlberg M, Glimelius B, Graf W, et al. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum 1998;41:543-549.
7
Heah SM, Eu KW, Ho YH, et al. Hartmann’s procedure vs. abdominoperineal resection for palliation of advanced low rectal cancer. Dis Colon Rectum 1997 ;40:1313-1317.
8
Rouffet F, Hay JM, Vacher B. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy: a prospective, controlled, multicenter trial. Dis Colon Rectum 1994;37:651-659.
9
Konishi T, Watanabe T, Kishimoto J, et al. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 2006;244:758-763.
10
Liang YC, Qing SH, Ding WX, et al. Total mesorectal excision versus conventional radical surgery for rectal cancer: a meta analysis. Zhonghua Wei Chang Wai Ke Za Zhi. 2007;10:43-48.
11
Pronio A, Di Filippo A, Narilli P, et al. Anastomotic dehiscence in colorectal surgery. Analysis of 1290 patients. Chir Ital. 2007;59:599-609.
12
Mulholland MW, Doherty GM. Complications in Surgery. Lippincott Williams and Wilkins. Philadelphia 2006: 504-505.
13
Kanellos I, Blouhos K, Demetriades H, et al. The failed intraperitoneal colon anastomosis after colon resection. Tech Coloproctol 2004;8:53-55.
14
Branagan G, Finnis D. Wessex Colorectal Cancer Audit Working Group. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 2005;48:1021-1026.
15
Chang SC, Lin JK, Yang SH, et al. Long-term outcome of anastomosis leakage after curative resection for mid and low rectal cancer. Hepatogastroenterology 2003;50:1898-1902.
16
Torralba J, Robles R, Parilla P. Subtotal colectomy vs. intraoperative colonic irrigation in the management of obstructed left colon carcinoma. Dis Colon Rectum 1998; 41:18-22.
17
Platell C, Barwood N, Dorfmann G, et al. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 2007;9:71-79.
18
Docherty JG, McGregor JR, Akyol AM, et al. Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 1995;221:176-184.
19
Hojo K, Koyama Y, Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg 1982;144:350-354.
20
Seow-Choen F, Goh HS. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg 1995;82:608-610.
21
Havenga K, Enker WE, Norstein J, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients. Eur J Surg Oncol 1999;25:368-374.
22
Ueno H, Mochizuki H, Hashiguchi Y, et al. Prognostic determinants of patients with lateral nodal involvement by rectal cancer. Ann Surg 2001;234:190-197.
23
Fujita S, Yamamoto S, Akasu T, et al. Lateral pelvic lymph node dissection for advanced lower rectal cancer. Br J Surg 2003;90:1580-1585.
24
Hasdemir O, Cöl C, Yalçin E, et al. Local recurrence and survival rates after extended systematic lymph-node dissection for surgical treatment of rectal cancer. Hepatogastroenterology 2005;52:455-459.
25
Matsuoka H, Masaki T, Sugiyama M, et al. Impact of lateral pelvic lymph node dissection on evacuatory and urinary functions following low anterior resection for advanced rectal carcinoma. Langenbecks Arch Surg 2005;390:517-522.
26
Artioukh DY, Smith RA, Gokul K. Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma. Colorectal Dis 2007;9:362-367.
27
Severini A, Civelli EM, Uslenghi E, et al. Diagnostic and interventional radiology in the post-operative period and follow-up of patients after rectal resection with coloanal anastomosis. Eur Radiol 2000;10:1101-1105.
28
Dehni N, Schlegel RD, Cunningham C, et al. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 1998;85:1114-1117.
29
Rullier E, Laurent C, Garrelon JL, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85:355-358.
30
Carlsen E, Schlichting E, Guldvog I, et al. Effect of the introduction of total mesorectal excision for the treatment of rectal cancer. Br J Surg 1998;85:526-529.
31
Mäkelä JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003;46:653-660.
32
Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 1997;185:105-113.
33
Pakkastie TE, Luukkonen PE, Järvinen HJ. Anastomotic leakage after anterior resection of the rectum. Eur J Surg 1994;160:293-297;
34
Tilney HS, Sains PS, Lovegrove RE, et al. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg 2007;31:1142-1151.
35
Boyle KM, Sagar PM, Chalmers AG, et al. Surgery for locally recurrent rectal cancer. Dis Colon Rectum 2005;48:929-937.
36
Riou JP, Cohen JR, Johnson H Jr. Factors influencing wound dehiscence. Am J Surg 1992;163:324-330.
37
Christian CK, Kwaan MR, Betensky RA, et al. Risk factors for perineal wound complications fol owing abdominoperineal resection. Dis Colon Rec-tum 2005;48:43-48.
38
Luna-Pérez P, Rodríguez-Ramírez S, Vega J, et al. Morbidity and mortality fol owing abdomi-noperineal resection for low rectal adenocarci-noma. Rev Invest Clin 2001;53:388-395.
