Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT

Kauv, Paul; Benadjaoud, Samir; Curis, Emmanuel; Boulay-Coletta, I.; Loriau, J.; Zins, Marc

doi:10.1007/s00330-015-3795-z

Cited by 44 publications

(48 citation statements)

References 26 publications

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“…The purpose of our study was to evaluate potential radiological variables to predict outcome of BC before initiating treatment rather than being an evaluation instrument after anastomosis salvage treatment, therefore including investigations on establishment of the AL diagnosis rather than from follow-up. When confirming AL, CE has been reported to be superior to a CT scan omitting rectal contrast in evaluating anastomotic integrity (8), thus this is the reason why we only included CE studies. The rationale for selecting certain radiological variables in this exploratory work was based on putative reproducibility and consistency rather than visual interpretations of morphological appearance as applied in one study (28).…”

Section: Discussionmentioning

confidence: 99%

“…Contrast enema (CE) is a radiological method to demonstrate established criteria for AL (6). CE has been reported as having high specificity and moderate sensitivity for AL with a high correlation to clinical findings (7) and is considered superior to computed tomography (CT) without rectal contrast in evaluating AL (8). CE can be employed to confirm a suspicion of AL or to evaluate anastomotic integrity before defunctioning stoma reversal (7).…”

Section: Introductionmentioning

confidence: 99%

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Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Jutesten

Lydrup

Landberg

et al. 2020

Acta Radiologica Open

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Background: Permanent stoma (PS) is common following treatment of anastomotic leakage (AL) after anterior resection (AR) and ways of predicting successful treatment outcome are missing. Purpose: To explore radiological variables in rectal contrast studies in their relation to end-result of PS following treatment for AL after AR. Material and Methods: The Swedish Cancer Registry (SCRCR) was explored for AL cases after AR for rectal cancer in patients operated in the region of Skåne from 1 January 2001 to 31 December 2011. Among identified AL cases, patients subjected to radiological imaging consistent with AL were evaluated according to a predetermined set of radiological variables. Information of PS as the end-result after AL treatment were retrieved from medical records. Results: Thirty-two patients had radiological imaging available for analysis confirming AL after AR; PS rate after a median follow-up of 87 months (range ¼ 21-165) after AR was 62%. Radiological findings compatible with abscess (P ¼ 0.023) and a leak size 6 mm (P ¼ 0.049) were significantly associated with PS. Conclusion: In this limited explorative study, our findings suggest that abscess status and leak size could correspond to outcome of PS in treatment for AL after AR. Additional studies are warranted to further explore this subject.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Jutesten

Lydrup

Landberg

et al. 2020

Acta Radiologica Open

View full text Add to dashboard Cite

show abstract

“…Recent studies by Huiberts et al [ 9 ] and Kauv et al [ 10 ] showed that leakage of contrast medium was the only independent predictive factor for AL. In our institution, abdominal CT scanning with rectal contrast enema (RCE) in cases where there is suspicion of AL has been the standard imaging procedure for over 6 years.…”

Section: Introductionmentioning

confidence: 99%

Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern

et al. 2017

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BackgroundEarly detection of anastomotic leakage (AL) after colorectal surgery followed by timely reintervention is of crucial importance. The aim of this study was to investigate the accuracy of computed tomography (CT) imaging for AL and the effects of delay in reintervention after a false-negative CT.MethodsAll files from patients who had colorectal surgery with primary anastomoses between 2009 and 2014 were reviewed. The predictive value of CT scanning for AL was determined and correlated with short-term postoperative patient outcomes. In addition, factors predictive of false-negative scans were assessed.ResultsSix hundred and twenty-eight patient files were reviewed. In total, a CT scan was performed in 127 patients. Overall, leakage was seen in 49 patients (7.8%). The positive and negative predictive values were 78 and 88%, respectively. Sensitivity was 73% and specificity 91%. In patients with a true-positive CT (n = 24), reintervention followed after a median interval of 0 days (IQR 1), whereas this was 1 day (IQR 2) in the false-negative group (n = 11) (p < 0.05). This was associated with a significantly increased mortality rate (1/24 = 4.2% vs 5/11 = 45.5%) (p < 0.005), an increased length of hospital stay [median 28 days (IQR 26) vs 54 days (IQR 20) (p < 0.05)].ConclusionsDelayed reintervention after false-negative CT scanning is associated with a high mortality rate and a significant increase in length of hospital stay.

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“…Previous studies have shown that assessment of specific CT findings was useful for the prediction of anastomotic leakage after gastric and colorectal surgery [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of a CT-based scoring system for diagnosis of anastomotic leakage after esophagectomy: comparison with subjective CT assessment

et al. 2017

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ObjectiveTo develop a CT-based prediction score for anastomotic leakage after esophagectomy and compare it to subjective CT interpretation.MethodsConsecutive patients who underwent a CT scan for a clinical suspicion of anastomotic leakage after esophagectomy with cervical anastomosis between 2003 and 2014 were analyzed. The CT scans were systematically re-evaluated by two radiologists for the presence of specific CT findings and presence of an anastomotic leak. Also, the original CT interpretations were acquired. These results were compared to patients with and without a clinical confirmed leak.ResultsOut of 122 patients that underwent CT for a clinical suspicion of anastomotic leakage; 54 had a confirmed leak. In multivariable analysis, anastomotic leakage was associated with mediastinal fluid (OR = 3.4), esophagogastric wall discontinuity (OR = 4.9), mediastinal air (OR = 6.6), and a fistula (OR = 7.2). Based on these criteria, a prediction score was developed resulting in an area-under-the-curve (AUC) of 0.86, sensitivity of 80%, and specificity of 84%. The original interpretation and the systematic subjective CT assessment by two radiologists resulted in AUCs of 0.68 and 0.75 with sensitivities of 52% and 69%, and specificities of 84% and 82%, respectively.ConclusionThis CT-based score may provide improved diagnostic performance for diagnosis of anastomotic leakage after esophagectomy.Key Points• A CT-based score provides improved diagnostic performance for diagnosis of anastomotic leakage.• Leakage associations include mediastinal fluid, mediastinal air, wall discontinuity, and fistula.• A scoring system yields superior diagnostic accuracy compared to subjective CT assessment.• Radiologists may suggest presence of anastomotic leakage based on a prediction score.

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Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT

Cited by 44 publications

References 26 publications

Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma

Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern

Diagnostic performance of a CT-based scoring system for diagnosis of anastomotic leakage after esophagectomy: comparison with subjective CT assessment

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