High complication rate after low anterior resection for mid and high rectal cancer; results of a population-based study I.S. Bakker a, * ,e , H.S. Snijders b,e , M.W. Wouters c , K. Havenga a , R.A.E.M. Tollenaar b , T. Wiggers a , J.W.T. Dekker d a University Medical Center Groningen, Department of Abdominal Surgery, University of Groningen, Groningen, The Netherlands b Leiden University Medical Center, Department of Surgery, Leiden, The Netherlands c Netherlands Cancer Institute e Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Amsterdam, The Netherlands d Reinier de Graaf Hospital, Department of Surgery, Delft, The Netherlands Accepted 18 February 2014 Available online 28 February 2014 Abstract Background: Surgical resection is the cornerstone of treatment for rectal cancer patients. Treatment options consist of a primary anasto- mosis, anastomosis with defunctioning stoma or end-colostomy with closure of the distal rectal stump. This study aimed to compare post- operative outcome of these three surgical options. Methods: Data was derived from the national database of the Dutch Surgical Colorectal Audit. Mid and high rectal cancer patients who underwent rectal cancer resection between January 2011 and December 2012 were included. Endpoints were postoperative complications including anastomotic leakage, reinterventions, hospital stay and mortality within 30 days postoperative. Results: In total, 2585 patients were included. Twenty-five per cent of all patients received a primary anastomosis; 51% an anastomosis with defunctioning stoma, and 24% an end-colostomy. More than one third of patients developed postoperative complications, the lowest rate being in the primary anastomosis group. Anastomotic leakage rates were 12% in patients with a primary anastomosis, and 9% in patients with an anastomosis with defunctioning stoma (p < 0.05). Multivariate analysis showed more postoperative complications, prolonged hos- pital stay, and increased mortality rates in patients with a defunctioning stoma or end-colostomy. The latter had proportionally less invasive reinterventions when compared to the other two groups. Conclusions: Patients with a primary anastomosis had the best postoperative outcome. A defunctioning stoma leads to a lower anastomotic leakage rate, though is associated with higher rates of complications, prolonged hospital stay and mortality. The decision to create a de- functioning stoma should be focus of future studies. Ó 2014 Elsevier Ltd. All rights reserved. Keywords: Rectal cancer; Malignancy; Low anterior resection; Postoperative complications; Surgical outcome; National audit Introduction Colorectal cancer is the third most common malignancy worldwide, with in the Netherlands more than 12 000 new cases each year. 1 The treatment for colorectal cancer requires a multidisciplinary approach with surgical resection as corner- stone of treatment. In the Netherlands, approximately 10 000 patients per year undergo a resection for colorectal cancer, from which 2,500 patients are operated on for rectal cancer. 2 * Corresponding author. University Medical Center Groningen, Depart- ment of Abdominal Surgery, P.O. Box 30.001, 9700RB Groningen, The Netherlands. Tel.: þ31 50 361 1505; fax: þ31 50 361 1745. E-mail addresses: ilsalienbakker@gmail.com, i.s.bakker@umcg.nl (I.S. Bakker). e Both authors equally contributed to this manuscript. 0748-7983/$ - see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejso.2014.02.234 Available online at www.sciencedirect.com ScienceDirect EJSO 40 (2014) 692e698 www.ejso.com