Original Paper

Risk Factors and Management of Presacral Abscess following Total Mesorectal Excision for Rectal Cancer
A.A.F.A. Veenhof^a, R. Brosens^b, A.F. Engel^b, D.L. van der Peet^a, M.A. Cuesta<sup>a

a</sup>Department of Surgery, Vrije Universiteit Medical Center, Amsterdam, and
^bDepartment of Surgery, Zaans Medical Center, Zaandam, The Netherlands

Address of Corresponding Author

Dig Surg 2009;26:317-321 (DOI: 10.1159/000231882)

  Key Words

• TME
• Presacral abscess
• Rectal cancer

  Abstract

Introduction:There is scant information regarding the incidence, risk factors and management of presacral abscesses following total mesorectal excision (TME) for rectal cancer. Methods:Gender, age, body mass index (BMI), neoadjuvant radiation therapy, ASA classification, tumor size, tumor localization and fecal diversion were investigated as independent risk factors for the development of a presacral abscess. Results: 261 patients were included, 26 patients (10%) developed a presacral abscess. Twenty-two patients (14.8%) with and 4 patients (3.6%) without neoadjuvant radiation therapy developed a presacral abscess (p = 0.003), respectively. Nine ASA 1 patients (5.7%), 8 ASA 2 patients (8.5%) and 3 ASA 3 patients (70%) developed a presacral abscess (p = 0.001). More presacral abscesses were observed after resection of larger tumors: 38 versus 30 mm (p = 0.041). No correlation between gender, age, BMI, tumor localization and the development of a prescaral abscess was found. Management of the presacral abscess, without overt leakage, was initially performed by drainage through the anastomosis following anterior resections and through the perineal suture line following abdominoperineal resections. Conclusion: Presacral abscess is a frequent (10%) complication following TME for rectal cancer. Patients in poor general condition, neoadjuvant radiation therapy and large tumors are at risks for developing a presacral abscess. Management, without overt leakage, is in our experience best executed by drainage through the anastomosis or perineal suture line.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Miguel A. Cuesta
Vrije Universiteit Medical Center
Department of Surgery, Post bus 7057
NL-1007 MB Amsterdam (The Netherlands)
Tel. +31 20 444 4781, Fax +31 20 444 4511, E-Mail ma.cuesta@vumc.nl

  Article Information

Received: February 18, 2009
Accepted: May 25, 2009
Published online: August 5, 2009
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 2, Number of References : 17