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Risk Factors and Management of Presacral Abscess following Total Mesorectal Excision for Rectal Cancer

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.