Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery

Snijders, H.S.; Henneman, D.; Leersum, N L van; Berge, M. Ten; Fiocco, Marta; Karsten, Tom; Havenga, Klaas; Wiggers, Theo; Dekker, Jan Willem T.; Tollenaar, Rob A.E.M.; Wouters, Michel W. J. M.

doi:10.1136/bmjqs-2012-001644

Cited by 21 publications

(7 citation statements)

References 49 publications

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“…The performance of models for anastomotic leakage was relatively poor. This is consistent with previous research showing that postoperative complications are more difficult to predict on the basis of patient characteristics than postoperative mortality. This raises the hypothesis that their occurrence is determined by the quality of surgical care and to a lesser extent by patient characteristics.…”

Section: Discussionsupporting

confidence: 92%

Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer

Fischer

Lingsma

Hardwick

et al. 2015

British Journal of Surgery

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Section: Discussionsupporting

confidence: 92%

Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer

Fischer

Lingsma

Hardwick

et al. 2015

British Journal of Surgery

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“…The DSCA facilitates individual hospitals in quality improvement projects, but is also used to identify treatment and outcome patterns for different patient groups. AL after colorectal resection has been selected as an outcome indicator for surgical quality of care in the DSCA. In rectal cancer surgery, the practice of routine construction of a defunctioning stoma may play a large role in measuring this outcome and determining risk factors, whereas stoma construction may be of less importance in colonic cancer resections.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit

Bakker

Grossmann

Henneman

et al. 2014

British Journal of Surgery

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296

219

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“…Low anterior resection (LAR) for rectal cancer with a low colorectal anastomosis (CRA) or coloanal anastomosis (CAA) is associated with substantial morbidity . One of the most feared complications after colorectal surgery is anastomotic leakage, with a reported incidence of between 1% and 19% . A diverting ileostomy has been shown to reduce symptomatic anastomotic leakage, but it still remains a serious complication with extensive consequences .…”

Section: Introductionmentioning

confidence: 99%

Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer: an analysis of 59 cases

et al. 2018

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Aim The construction of a new coloanal anastomosis (CAA) following anastomotic leakage after low anterior resection (LAR) is challenging. The available literature on this topic is scarce. The aim of this two-centre study was to determine the clinical success and morbidity after redo CAA.Method This retrospective cohort study included all patients with anastomotic leakage after LAR for rectal cancer who underwent a redo CAA between 2010 and 2014 in two tertiary referral centres. Short-and long-term morbidity were analysed, including both anastomotic leakage and permanent stoma rates on completion of follow-up.Results A total of 59 patients were included, of whom 45 (76%) were men, with a mean age of 59 years (SD AE 9.4). The median interval between index and redo surgery was 14 months [interquartile range (IQR) 8-27]. The median duration of follow-up was 27 months . The most frequent complication was anastomotic leakage of the redo CAA occurring in 24 patients (41%), resulting in a median of three reinterventions (IQR 2-4) per patient. At the end of follow-up, bowel continuity was restored in 39/59 (66%) patients. Fourteen (24%) patients received a definitive colostomy and six (10%) still had a diverting ileostomy. In a multivariable model, leakage of the redo CAA was the only risk factor for permanent stoma (OR 0.022; 95% CI 0.004-0.122).Conclusion Redo CAA is a viable option in selected patients with persisting leakage after LAR for rectal cancer who want their bowel continuity restored. However, patients should be fully informed about the relatively high morbidity and reintervention rates.Keywords Redo surgery, rectal cancer, low anterior resection, anastomotic leakage, hand-sewn coloanal anastomosis What does this paper add to the literature? This is one of the largest homogeneous cohort studies on anastomotic leakage after low anterior resection for rectal cancer that is treated with the construction of a new coloanal anastomosis. This study shows that this complex and still quite rare procedure results in moderate success with significant associated morbidity.

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Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery

Cited by 21 publications

References 49 publications

Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer

Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer

Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit

Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer: an analysis of 59 cases

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