P-0292 Peri–Operative Outcomes of Abdominotransanal Resection With Total Mesorectal Excision and Transanal Handsewn Coloanal Anastomosis for Primary Distal Rectal Adenocarcinoma

Abstract

ABSTRACT Introduction This study aimed to provide a report on the peri – operative outcomes as well as the factors that contribute to the development of complications on patients with primary distal rectal cancer who underwent abdominotransanal resection (ATAR) with total mesorectal excision (TME) and transanal handsewn coloanal anastomosis (CAA). Methods This was a retrospective study conducted by the Division of Colorectal Surgery at the University of the Philippines – Philippine General Hospital that evaluated seventy nine consecutive adult patients who underwent ATAR with TME and CAA for primary distal rectal cancer from January 1, 2008 to December 31, 2010. Variables such as age, gender, comorbidities, pre – operative serum albumin level, smoking history, utilization of neoadjuvant therapy, distance of tumor from anal verge, surgical approach, quality of surgical specimen, circumferential resection margin (CRM) status, pathologic stage, length of post – operative hospital stay, type of anesthesia, morbidity, and mortality were recorded and analyzed. Results Of the seventy nine patients, nineteen patients (24.05 per cent) had a CAA dehiscence: three patients (3.8 per cent) required a relaparotomy with evacuation of intra – abdominal abscess, six patients (7.59 per cent) underwent transanal drainage of pelvic abscess; and ten patients (12.66 per cent) who presented with pelvic abscess on computed tomography scan (3), purulent discharge with minor coloanal anastomotic disruption (3), and fistula (4) were managed non – operatively. Diabetes mellitus (p=0.043), history of smoking (p=0.037), and CRM positivity (p=0.050) were found to be statistically significant factors in increasing the incidence of CAA dehiscence. Conclusion Diabetes mellitus, history of smoking, and CRM positivity lead to a statistically significant increase in contributing to the development of anastomotic dehiscence following ATAR with TME and CAA for primary distal rectal cancer.