Anastomotic leakage after side‐to‐end anastomosis for rectal cancer: does leakage location matter?

Hain, Élisabeth; Maggiori, Léon; Zappa, Magaly; Denise, J. Prost à la; Panis, Yves

doi:10.1111/codi.14005

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…In this subgroup of patients, we have already noted a reduction in the AL rate from 24% to 14% [26]. This can be explained, at least in part, by the removal of the potential leak on the colonic stump after STE anastomosis, which was observed in 39% of all the leaks in our patients with STE anastomosis as we observed in a previous paper [27].…”

Section: Discussionsupporting

confidence: 85%

Delayed pull‐through coloanal anastomosis without temporary stoma: an alternative to the standard manual side‐to‐end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer

et al. 2022

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Aim After total mesorectal excision (TME) for low rectal cancer, current guideline recommendations for sphincter‐saving surgery are to perform a side‐to‐end manual coloanal anastomosis (CAA) (or with J‐pouch) with a temporary stoma. Our study aimed to evaluate if delayed pull‐through coloanal anastomosis (DCAA) without a temporary stoma could represent a safe alternative in low rectal cancer. Method From 2003 to 2020, 223 consecutive patients with low rectal cancer undergoing TME were compared: CAA and diverting stoma (n = 190) versus DCAA without stoma (n = 33). Results Overall 3‐month and severe (Dindo ≥ IIIb) morbidity rates were similar in CAA versus DCAA groups: 34% (65/190) vs. 36% (12/33) and 2.6% (5/190) vs. 3% (1/33), respectively. In the DCAA group, only one patient (3%) underwent reoperation (Hartmann's procedure) at day 3 due to colon necrosis. The anastomotic leakage rate (both clinical and radiological) was significantly higher after CAA than DCAA: 28% (53/190) vs. 3% (1/33; p = 0.00138). Failure of the procedure (with return to stoma) was observed in 8% (15/190) vs. 6% (2/33) of patients after CAA and DCAA respectively (not significant). Conclusion Our comparative study suggested that in patients with low rectal cancer, DCAA without a temporary stoma could represent an interesting alternative to the actual recommended CAA with a temporary ileostomy. DCAA could offer two major advantages over CAA: a significantly lower rate of anastomotic leakage and absence of a temporary stoma and its potential complications (rehospitalization, dehydration, wound hernia after stoma closure).

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Section: Discussionsupporting

confidence: 85%

Delayed pull‐through coloanal anastomosis without temporary stoma: an alternative to the standard manual side‐to‐end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer

et al. 2022

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“…The location of AL after side-to-end anastomosis, i.e. from the circular stapling line or from the transverse stapler line in the colonic stump, established with CE was not shown to be associated with morbidity, low anterior resection syndrome, or rate of PS (26). Radiological morphology has previously been explored in relation to non-closure of defunctioning stoma.…”

Section: Discussionmentioning

confidence: 99%

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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“…In our study, not all CT imaging reports are consistent with the intraoperative findings, which may be due to the changes in intestinal anatomy, intestinal distention, pneumoperitoneum, and other reasons; these changes may also affect the surgeons observing the lesions. The existence of a drainage tube and a circular stapler can also lead to inadequate preparation for image examination and the failure of CT examination [ 26 ]. In addition, the coexistence of the lesions with these complications makes the correct diagnosis more difficult.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Clinical Usefulness of Preoperative Computed Tomography in Colorectal Cancer Patients Who Received Unplanned Reoperation

Gao

et al. 2020

Gastroenterology Research and Practice

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Background. In the unplanned reoperation of colorectal cancer patients, computed tomography (CT) is increasingly utilized to locate postoperative complications and previously unlocalized lesions. The purpose of this study is to explore the application of CT in the mortality and complications of the reoperation of colorectal cancer. Patients and Methods. We performed a retrospective review of collected data from the colorectal surgeries of 90 identified colorectal cancer patients who received an unplanned reoperation from 2010 to 2018. Patients were stratified according to those with preoperative CT imaging (CT group, n=36) and those without preoperative CT imaging (NCT group, n=54). Twenty-four statistical indicators of each patient were studied, including their preoperative risk, surgical characteristics, and postoperative outcomes, and satisfaction was evaluated. All data were statistically analysed for predicting postoperative complications by univariate and multivariate logistic regression analyses. Results. Ninety patients received an unplanned reoperation in the study, and 40% (36/90) of these patients underwent preoperative CT examination. Patients’ risk factors were similar between CT and NCT groups. Preoperative imaging was more commonly performed for reoperative new anastomosis + ileostomy but less common for reoperative Dixon’s procedure. The operative duration of the NCT group was longer (139 vs. 104 min, respectively, P=0.01). Preoperative NCT examination (OR 1.24; 95% CI=1.09‐1.42; P=0.01) was an independent predictor of postoperative complications. Importantly, three patients died after an unplanned reoperation for colorectal cancer, which occurred only in the NCT group (5.6% vs. 0.0%, P=0.01). Conclusion. The use of conventional preoperative CT optimizes the choice of the surgical site and the strategy of laparotomy, so as to reduce the length of operation. Preoperative imaging evaluation should be performed for patients undergoing repeat abdominal surgery.

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Anastomotic leakage after side‐to‐end anastomosis for rectal cancer: does leakage location matter?

Abstract: Our study showed that whatever the location of AL on a side-to-end low colorectal or coloanal anastomosis after TME for cancer, both short and long-term outcomes are similar. This article is protected by copyright. All rights reserved.

Cited by 10 publications

References 19 publications

Delayed pull‐through coloanal anastomosis without temporary stoma: an alternative to the standard manual side‐to‐end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer

Delayed pull‐through coloanal anastomosis without temporary stoma: an alternative to the standard manual side‐to‐end coloanal anastomosis with temporary stoma? A comparative study in 223 patients with low rectal cancer

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

Assessment of the Clinical Usefulness of Preoperative Computed Tomography in Colorectal Cancer Patients Who Received Unplanned Reoperation

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