Significance of Closed Suction Drain Placement in Sphincter Saving Surgery for Rectal Cancer

Abstract

Purpose: We retrospectively evaluated the significance of closed suction drain placement in sphincter saving surgery for rectal cancer, and risk factors of anastomosis leakage.
Methods: One hundred fifty one patients who underwent elective sphincter saving surgery for rectal cancer with the closed suction drain at anterior site of sacrum were subjected. We investigated the frequency of anastomosis leakage, treatment for the leakage, amount of intrapelvic fluid through the drain, and risk factors of the leakage. The incidence and severity of anastomosis leakage was determined using the criteria established by the International Study Group of Rectal Cancer (ISREC) group.
Results: The anastomosis leakage was found in 6 patients (4.0%), three patients with the leakage at posterior site of the anastomosis were classified as Grade A, one patients with the leakage at stump of the side-to-end anastomosis was classified as Grade B, and two patients with the leakage at anterior site of the anastomosis were classified as Grade C. Amount of intrapelvic fluid of patients with the leakage was significantly higher than that of patients without the leakage in the postoperative day 1 (p=0.04), but there was not significant different between these patients in the postoperative day 2 and 3. In the univariate logistic regression analysis, the lateral lymph node dissection (performed, p<0.01) and the time of drain removal (≧ 6 day, p=0.06) were selected. The lateral lymph node dissection (performed, p=0.04) was recognized as a significant independent risk factor for anastomosis leakage by the multivariate logistic regression analysis.
Conclusion: Our current results suggested that closed suction drain placement in sphincter saving surgery for rectal cancer might be useful for a part of patients considering the risk of anastomosis leakage.