Benefit of extraperitonization to prevent septic intraabdominal complications after distal rectal cancer surgery

Colorectal cancer is one of the most common oncological diseases. Surgery is the main treatment modality and laparoscopic colorectal resection has been gaining popularity over the past two decades. Neoadjuvant therapy is considered standard treatment for 2nd and 3rd stage distal rectal cancer. We present our retrospective study of 127 patients with anterior rectum resection (ARR) and total mesorectal excision (TME) for low rectal cancer operated on between 2012 and 2015 in two surgical wards. In all 59 laparoscopic ARR neoadjuvant therapy, intraabdominal drainage and ileostomy was performed, while extra-peritonization was done in 21 and no pre-sacral drainage was used. In the conventional group of 68 ARR, 21 had neo-adjuvant therapy, everyone has had extra-peritonization, pre-sacral drainage and no protective ileostomy performed. Early postoperative complications were registered in 25 patients, 24 related to the operation and 1 due to a recurrent brain stroke, all classified from I to III by Clavien Dindo scale. There were 9 anastomosis insufficiences: 6 in conventional and 3 in laparoscopic operations. In 3 patients (2 conventional and 1 laparoscopic) with low ARR and signs of peritoneal contamination re-laparotomy was performed with successive outcome. All patients survived. Our routine practice of extra-peritonization and pre-sacral-perianal drainage in open ARR eliminate the possibility of postoperative peritonitis after anastomosis insufficiency, limiting the infection to low pelvic phlegmona and local intra-abdominal pelvic infection in overlooked cases.