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A‘high tie’confers an increased risk of anastomotic leakage for lower rectal cancer surgery in patients treated with preoperative radiotherapy

Surgery Today, ISSN: 1436-2813, Vol: 45, Issue: 5, Page: 600-605
2015
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Purpose: This study aimed at analyzing retrospectively the risk factors for anastomotic leakage for lower rectal cancer treated with preoperative radiotherapy. Methods: The subjects were 108 patients with T3 lower rectal cancer, who underwent curative resection following preoperative radiotherapy. All patients had a diverting stoma made. Univariate and multivariate analyses were conducted for the independent clinical variables. Results: Anastomotic leakage developed in 19 (17.6 %) patients. Univariate analysis of the risk factors for anastomotic leakage revealed that arterial ligation with a high tie (p = 0.001), undifferentiated tumor type (p = 0.002), a shorter distance from the anal verge (p = 0.086), and a longer hospital stay (p = 0.0002) were significant predictors of leakage. Multivariate analysis revealed that a high tie [hazard ratio 12.22 (95 % confidence interval 2.83–87.94); p = 0.0003], undifferentiated tumor type [91.15 (5.98–3128.03); p = 0.0008], and a long hospital stay [13.03 (2.86–104.93); p = 0.0004] were independently associated with anastomotic leakage. Conclusion: Our data suggest that preoperative radiotherapy and a high tie for lower rectal cancer are independent risk factors for anastomotic leakage.

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