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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