Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: A prospective study of 978 patients

Objective: The objective of this study was to investigate prophylactic pelvic drainage and other factors that might be associated with anastomotic leakage after elective anterior resection of primary rectal cancer. Summary Background Data: Anastomotic leak after anterior resection for primary rectal cancer leads to significant postoperative morbidity and mortality. The role of pelvic drainage in the prevention of anastomotic leakage is controversial. Methods: We investigated 978 consecutive patients undergoing elective anterior resection for primary rectal cancer between February 1995 and December 1998 in a single institution. Use of a drain and type of drainage were at the surgeon's preference. Data were prospectively collected during hospitalization. Twenty-five independent tumor-, patient-, and treatment-related variables were analyzed. The dependent variable was clinical anastomotic leakage. A binary logistic regression analysis was used to assess the independent association of variables with the dependent variable. Results: The clinical anastomotic leakage rate was 2.8%. Independent risk factors for anastomotic leakage were use of an irrigation-suction drain (odds ratio [OR], 9.13; 95% confidence interval [CI], 1.16-71.76), blood transfusion, poor colon preparation (OR, 2.58; 95% CI, 1.10-5.88), and anastomotic level 5 cm or less from the anal verge (OR, 2.38; 95% CI, 1.03-5.46). Conclusions: Routine use of pelvic drainage is not justified and should be discouraged. In cases in which pelvic drainage is required such as in difficult operations or to prevent pelvic hematoma, pelvic drainage other than irrigation-suction should be considered.