Anastomotic leakage following restorative rectal cancer resection: treatment and impact on stoma presence 1 year after surgery—a population-based study

Eriksen, Jacob Damgaard; Emmertsen, Katrine Jøssing; Madsen, Anders Husted; Iversen, Lene Hjerrild

doi:10.1007/s00384-022-04164-0

Cited by 4 publications

(5 citation statements)

References 36 publications

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“…In line with previous studies, 33–35 almost half of the leakage patients in this study had an unplanned stoma 1 year after surgery. Also, temporary stomas that are not closed within 1 year are highly likely to become permanent, as stoma closure is uncommonly performed after this time 33,36 . The role of defunctioning stoma creation at index surgery to decrease the severity of AL has been debated, 37,38 but this current study demonstrated the long-term negative consequences.…”

Section: Discussionsupporting

confidence: 91%

“…The main contributor to the risk of a permanent stoma after RC resection is AL, and among patients who developed AL, this is often the underlying reason. 33 In line with previous studies, 33 – 35 almost half of the leakage patients in this study had an unplanned stoma 1 year after surgery. Also, temporary stomas that are not closed within 1 year are highly likely to become permanent, as stoma closure is uncommonly performed after this time.…”

Section: Discussionsupporting

confidence: 89%

“…The main contributor to the risk of a permanent stoma after RC resection is AL, and among patients who developed AL, this is often the underlying reason 33 . In line with previous studies, 33–35 almost half of the leakage patients in this study had an unplanned stoma 1 year after surgery.…”

Section: Discussionsupporting

confidence: 83%

“…Also, temporary stomas that are not closed within 1 year are highly likely to become permanent, as stoma closure is uncommonly performed after this time. 33 , 36 The role of defunctioning stoma creation at index surgery to decrease the severity of AL has been debated, 37 , 38 but this current study demonstrated the long-term negative consequences. Holmgren et al 39 confirmed the phenomena that defunctioning stomas created at index surgery are significantly associated with permanent stomas, and in this study, the effect of AL was considered small.…”

Section: Discussionmentioning

confidence: 65%

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Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage

Greijdanus¹,

Wienholts

Ubels³

et al. 2023

Annals of Surgery

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Objective: This study aimed to develop and validate a prediction model (STOMA-score) for one-year stoma-free survival in rectal cancer (RC) patients with anastomotic leakage (AL). Background: AL after RC resection often results in a permanent stoma. Methods: This international retrospective cohort study (TENTACLE–Rectum) encompassed 216 participating centres, and included patients who developed AL after RC surgery between 2014-2018. Clinically relevant predictors for one-year stoma-free survival were included in uni- and multivariable logistic regression models. The STOMA-score was developed and internally validated in a cohort of patients operated between 2014-2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models’ performance were evaluated. Results: This study included 2499 AL patients; 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA-score: sex, age, ASA-classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal- and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction and reactivation leakage. The STOMA-score showed good discrimination and calibration (c-index 0.71, 95%CI 0.66-0.76). Conclusion: The STOMA-score consists of eighteen clinically relevant factors and estimates the individual risk for one-year stoma-free survival in patients with AL after RC surgery, which may improve patient counselling and give guidance when analyzing efficacy of different treatment strategies in future studies.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 65%

See 2 more Smart Citations

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage

Greijdanus¹,

Wienholts

Ubels³

et al. 2023

Annals of Surgery

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“…Another comparative study was undertaken by Eriksen et al . 40 , who reported significantly higher stoma rates 1 year after EVT compared with conventional management (33.9 versus 13.5 per cent). This could also explain the higher rates of secondary salvage surgery and ICU admission in the present study, as patients treated with EVT had larger anastomotic defects and retraction at baseline compared with those treated conventionally.…”

Section: Discussionmentioning

confidence: 95%

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Greijdanus,

Wienholts,

Ubels

et al. 2023

British Journal of Surgery

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Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1). Results Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of −1.1 (95 per cent c.i. −9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (−28 to 52) days). Conclusion Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.

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