Elective resection and anastomosis for colorectal cancer: A prospective audit of mortality and morbidity 1976−1998

BACKGROUND: The purpose of this paper is to audit the morbidity and mortality for colorectal cancer after open elective resection and anastomosis by a single colorectal surgeon (MK), with reference to any differences between intraperitoneal (IPA) and extra-peritoneal anastomoses (EPA). METHODS: The prospective documentation of postoperative complications was compiled by the surgeon, charge nurses and a research assistant (PB). The operations were performed in three hospitals between 1976 and 1998. RESULTS: Some 1392 consecutive patients were treated electively by 1418 resections with anastomosis. There were 23 postoperative deaths (1.6%). Significant adverse events, which were potentially avoidable, occurred in 10 (43.5%) of the patients who died. The morbidity rate was 41.6%. Clinical anastomotic leaks occurred more frequently in EPA (27/581, 4.7%) than in IPA (2/827, 0.2%; P < 0.0001). Anastomotic leak caused the death of two patients (0.14%).Routine prophylactic anticoagulation did not decrease the incidence of pulmonary embolism. Significant thrombophlebitis at the intravenous cannula site occurred in 54 patients (3.8%), wound infection in 29 (2.1%), and postural peripheral nerve injury in the upper limbs occurred in 11 patients (0.8%). Thirty-eight patients (2.7%) were returned to the operating theatre for 42 unscheduled operations. CONCLUSION: Mortality associated with elective resection of colorectal cancer with anastomosis is principally related to age, cardio-vascular disease and avoidable adverse events. A wide range of complications may follow this type of surgery, especially after extra peritoneal operations. A classification of anastomotic leaks is suggested to assist in comparisons of this complication which remains a significant concern following extra peritoneal anastomoses.