Lee et al evaluate patients undergoing total mesorectal excision of a rectal carcinoma. They identified a number of factors affecting the outcome. The authors are from Sungkyunkwan University in Seoul, Korea.


Patient selection: rectal cancer, following total mesorectal excision


Risk factors for anastomotic leak:

(1) male gender

(2) preoperative concomitant chemoradiation

(3) surgical duration > 120 minuts


If no leakage occurred, the 5-year survival was 80%.

If leakage occurred, the 5-year surgival was 65%.


Features of the tumor associated with a worse survival:

(1) T stage T3 or T4

(2) lymph node metastases

(3) lymphovascular invasion present

(4) CEA > 5 ng/mL

A larger or more extensive tumor would be more likely to require preoperative chemoradiation and require a longer operation, which would correlate with a greater risk of leakage.


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