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August 1, 1994British journal of surgery

Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum

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Authors

NKN D KaranjiaRoyal Surrey NHS Foundation TrustACA P CorderTulane UniversityPBPhilip BearnAshford and St Peter's Hospitals NHS Foundation Trust

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Implication

Cohort study demonstrates major anastomotic leakage risks after total mesorectal excision for rectal cancer, indicating protective effects of defunctioning stomas.

Key Points

  • To determine the incidence, risk factors, and clinical consequences of anastomotic leakage following low anterior resection with total mesorectal excision for rectal cancer.
  • Retrospective analysis of 219 patients who underwent low anterior resection of the rectum with total mesorectal excision out of 276 rectal cancer surgeries performed over a 14-year period.
  • Evaluated major anastomotic leaks (associated with peritonitis or pelvic collection) and minor leaks (asymptomatic, detected by contrast enema) across anatomical and technical variables.
  • Major anastomotic leaks occurred in 11.0% of patients (24/219) and minor leaks in 6.4% (14/219), with all major leaks occurring at an anastomotic height under 6 cm (P = 0.08).
  • Major leakage was higher without a defunctioning stoma (11/62 [17.7%] vs 13/157 [8.3%], P = 0.03); peritonitis occurred in seven patients with major leaks, but only one had a defunctioned anastomosis (P = 0.002), with three total deaths (P = 0.02).
  • Use of the sigmoid colon resulted in higher major leak rates than mobilizing the splenic flexure (7/32 [21.9%] vs 17/187 [9.1%], P = 0.05).

Cite This Study

Karanjia et al. (1994) studied this question.

synapsesocial.com/papers/69db22d10d8d6ef495a3cf67https://doi.org/10.1002/bjs.1800810850
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The blood-supply to the sigmoid colon and rectum: With reference to the technique of rectal resection with restoration of continuity1949 · 61 citations
  2. 2Anterior resection without a defunctioning colostomy: questions of safety1992 · 128 citations
  3. 3Prospective audit of an extramucosal technique for intestinal anastomosis1991 · 34 citations
  4. 4Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma1992 · 85 citations
  5. 5Staples or sutures for low colorectal anastomoses: A prospective randomized trial1985 · 127 citations