Anastomotic Leakage after Resection of Distal Colorectal Carcinoma in Maharat Nakhon Ratchasima Hoapital
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Abstract
Colorectal cancer is the most common cancer of gastrointestinal tract. Leakage occurs in 1.5 – 17.4% of all colorectal cases. Objective: To identify the risk factors for infrapromontory colorectal anastomasis leak age after left sided colorectal resection with rectal anastomosis. Patients and Methods: A retrospective study of database of all patients with a diagnosis of colorectal cancer in Maharat Nakhon Ratchasima Hospital between 2005 and 2006 was conducted. The level of primary anastomosis was distal to the rectosigmoid junction (infrapromontory). Statistical analyses were mean, SD, percent, 95% CI, and Chi-square analysis with Yates correction. Results: Seventy-five patients consisted of 38 males and 37 females, mean age was 60.5 years. The common clinical presentations were mucous bloody stool and bowel habit change. The leakage rate was 9.3% and the mortality rate was 5.3%. The postoperative clinical variables significantly associated with anastomotic leakage included fever (>38oC) on day 2 (P=0.001), absence of bowel activity on day 4 (P=0.001), collection of more than 400 ml of fluid through abdominal drains from day 0 to day 3 (P=0.001), collection of more than 400 ml of fluid through abdominal drains from day 0 to day 3 (P<0.001),leukocytosis after day 7 (P=0.001), pelvic pain (P=0.001), cardiac symptom (P=0.001), diabetes mellitus (P=0.013), two or more underlying diseases (P=0.012) and short distance of the anastomosis to the verge (P=0.011). Conclusion: Operation of colorectal cancer at distal to the rectosigmoid junction (infrapromontory) in Maharat Nakhon Ratchasima Hospital had 9.3% leakage rate. It was related with diabetes mellitus, 2 or more underlying diseases, below rectum level of cancer, body temperature over 38 degree of Census on day 2th post operation, absence of bowel activity on day 4, fluid drainage over 400 cc within post operative day 1-3, leukocytosis at day 7th post operation, post operative pelvic pain and cardiac complications.
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References
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