Causes And Treatment Of Rectal Anastomotic Leakage

Background Rectal cancer is a sort of tumor which located in the junctionof sigmoidoscopy and rectum to the dentate line, it is an common digestivetract malignant tumors, get the second palce of gastrointestinal cancer and theincidence rate has been showed an increasing trend.Although the incidence rateof colorectal cancer increases every year, the technique of treatment is alsoimproved continuously to reduce the recurrence rate, ensure the radicalmastectomy and improve the quality of life. Rectal cancer ranges from60%to75%in colorectal cancer of our country, it is easily diagnosed by rectalexamination and sigmoidoscopy due to its lower location.The surgery isstill the most important treatment of the rectal cancer. However, its inner pelviclocation cause the difficulty of operation, high local recurrence rate and somany postoperative complications.Anastomotic leakage is one of the most important complications，Someexperts believe that the rectal anastomotic leakage is Related local and systemicfactors.Systemic factors are the following:The patient’s age, gender, preop-erative underlying diseases (hypertension, coronary heart disease, diabetes,lung disease, etc.) These factors do not have such strong influence as the localfactors(suture technique, formation of protective ileostomy, and blood supply atthe margin of anastomosis) Once the formation of anastomotic leakage, thelight extended the duration of hospitalization, and increase the burden of thepatient’s thinking and economic pressures, serious and even threaten the livesof patients.So attaches great importance to anastomotic leakage,avoid allfactors that can prevent, postoperative anastomotic leakage in patients to takeindividualized treatment approach, as much as possible to reduce the threatposed by anastomotic leakage to patients.Retrospective analysis of hospitalpatients, by comparing the various factors on the impact of anastomotic leakage, possible causes and provide a good theoretical basis for future prevention.Acombination of various experts in the treatment of ideas, to adopt the principleof individual treatment, and greatly improve the cure rate for patients withanastomotic leakage.Objective The aim of this study is to present the incidence of anastomoticleakage after anterior resection for rectal cancer and to demonstrate thetherapeutic approach for the treatment of this complication.Methods Retrospectively analyzed267rectal cancer patients which wereoperated by anal sphincter preservation surgery in our hospital from April2007to April2010. Low anterior resection with total mesorectal excision (TME) wasperformed in187, and high anterior resection in80patients. The definition ofthe anastomotic leakage was based on clinical symptoms and signs, peripheralblood examination, abdominal CT scan.Results28(10.5%) patients had anastomotic leakage, there is nostatistically significant difference in the incidence of andanastomotic leakagewith gender, age, whether with basic diseases (coronary heart disease, diabetes,hypertension, chronic bronchitis, emphysema, hypoproteinemia, anemia, ben-ign prostatic hyperplasia, urinary tract infection, etc.), Dukes stage, histolo-gi-caltype, lymph node metastasis and chemotherapy drugs in the pelvic. Twentypatients were managed conservatively, such as presacral drainage canal irrig-ation,nutritional support, antibiotics and somatostatin given, and eight largeanastomotic leak underwent secondary surgery.Conclusions The distance of tumor to anal margin and whether strengthenthe anastomotic stoma are the risk factors of anastomotic leakage after anteriorresection. Early diagnoses, taking an active, rational individualized treatmentdepending on the severity are the keys to mention the cure rate of rectal canceranastomotic leakage.