Short-term outcomes and oncologic clearance of side-to-end anastomosis after low anterior resection in rectal cancer patients

Background: Low anterior resection (LAR) is the procedure of choice to achieve oncologic resection and sphincter saving for rectal cancer patients. Although outcomes of side-to-end anastomosis after LAR were acceptable, most studies reported only a small number of cases and studies in Thai patients are limited. Objective: To determine short-term outcomes and oncologic clearance of side-to-end anastomosis after low anterior resection in rectal cancer patients. Material and Method: A retrospective patient charts review was performed. All patients with pathologically confirmed adenocarcinoma of the rectum who underwent LAR with side-to-end anastomosis in the Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital between July 2007 and April 2010 were included. Demographic, perioperative data and postoperative short-term outcomes were analyzed. Results: There were 113 patients with a mean age of 60 years; 57 (50.4%) males and 56 (49.6%) females. Six percent of the patients underwent preoperative neoadjuvant chemo-radiation. The average tumor location was 6.7 cm above the anal verge; 31 (27.4%) above, 37 (32.7%) at and 45 (39.8%) below the peritoneal reflection. Pathologically, most specimens were T3 tumors (67.3%) and half of the patients had positive lymph nodes. The median number of harvested lymph nodes was 18 and the resected surgical margins were 6.1% microscopically positive. The overall postoperative complication rate was 38.9%, anastomosis leakage rate was 6.2% and there was one death. The median time to regular diet resumption was 110 hours and the median hospital stay was 11 days. Conclusion: Short-term outcomes and oncologic clearance of low anterior resection with side-to-end anastomosis is comparable to reported outcomes in other studies. Long-term oncologic and functional outcomes need to be studied further.