Low colorectal anastomosis after pelvic exenteration for gynecologic malignancies: Risk factors analysis for leakage

Abstract

Objective: To study risk factors for low colorectal anastomotic leak after pelvic exenteration for gynecologic malignancies. Methods: Data from 60 patients, 32 with ovarian cancer and 28 with nonovarian cancer who underwent pelvic exenteration with colorectal anastomosis (CRA) were retrospectively analyzed. Results: Overall rate of CRA leak was 20%. The CRA leak was associated with type of tumor (3% for the ovarian cancer and 40.8% for the nonovarian cancer, P = 0.004), CRA height (<5 cm vs ≥5 cm, 75% vs 6.3%; P = 0.001), and previous radiotherapy (RT; 53.3% vs 8.9%; P = 0.001). Multivariate analysis showed that only previous RT and CRA height were associated with the CRA leak. Rectosigmoid wall involvement (81.8% vs 27%; P = 0.001) and mesorectum infiltration (69.2% vs 21.7%; P = 0.001) were more frequent among patients with ovarian cancer patients. Conclusion: Previous RT and CRA at or less than 5 cm from the anal verge pose a high risk for CRA leak. In these cases, a definitive colostomy should be recommended. ©2011 by IGCS and ESGO.