Can Transanal Tube Placement after Anterior Resection for Rectal Carcinoma Reduce Anastomotic Leakage Rate? A Single‐institution Prospective Randomized Study

Liang, Xiao; Zhang, Wenbo; Jiang, Pengcheng; Bu, Xuefeng; Yan, Qun; Li, Hua; Zhang, Yongjun; Yu, Feng

doi:10.1007/s00268-011-1053-3

Cited by 114 publications

(155 citation statements)

References 51 publications

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“…The thirteen reviewed studies included a total of N=3,023 patients (Table 3), [16,17,[19][20][21][22][23][24][25][26][27][28][29]. Study sample size and design was variable.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies required that staple anastomosis be employed [20][21][22][24][25][26][27], while the remaining six studies allowed multiple methods of anastomosis closure. Within these six studies that employed multiple anastomosis methods [16,19,23,[28][29][30], stapled anastomosis was always one of the methods used. Five of these six studies used either staple or suture based anastomosis, while the remaining study (Dauser et Intra-operative anastomotic leak testing was widely used with a total of n=2,598 (85.9%) patients receiving intra-operative testing (Table 4).…”

Section: Search Term Description Definitionmentioning

confidence: 99%

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Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Schiff¹,

Brady²,

Ghosh³

et al. 2016

J Surg Surgical Res

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048 AbstractPurpose: Anastomotic leak following colorectal resection surgery is associated with high rates of morbidity, infection, and escalated healthcare expenditures. One method to prevent leaks includes early detection through intra-operative testing. This study employed systematic review of the literature to estimate the rate of intra-operative anastomotic leaks in colorectal resection surgery. Method:The Medline and Embase databases were searched to identify articles published between January 1 st , 2003 and August 8 th , 2015 reporting on intra-operative leaks in colorectal resection. The rate of intra-operative testing, intra-and post-operative anastomotic leaks, and surgical methodology were extracted from the final sample of 13 articles.Results: A total of 167 intra-operative leaks were reported within 2,598 colorectal resection surgeries that used intra-operative testing, yielding an average leak rate of 6.4%. Use of laparoscopic techniques was significantly associated with a reduced rate of intra-operative leak (p<0.001). Eight articles reported on the rate of post-operative anastomotic leak in relation to intraoperative testing. Within this sample of 2,098 cases a non-significant trend towards a lower leak rate in the tested population was identified (4.3% v. 6.8%, p=0.051); cases whose leak test was initially positive exhibited a significantly higher rate of post-operative leaks compared to cases with a negative leak test (p=0.006). Conclusion:Intra-operative anastomotic leak testing allows surgeons to address leaks at the time of surgery, and may help to prevent complications in colorectal resection surgery. This study identified a mean intra-operative leak rate of 6.4% in colorectal resection surgery.

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“…The thirteen reviewed studies included a total of N=3,023 patients (Table 3), [16,17,[19][20][21][22][23][24][25][26][27][28][29]. Study sample size and design was variable.…”

Section: Resultsmentioning

confidence: 99%

Section: Search Term Description Definitionmentioning

confidence: 99%

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Schiff¹,

Brady²,

Ghosh³

et al. 2016

J Surg Surgical Res

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“…The use of ''ghost'' ileostomy, which allows selective loop ileostomy formation or early closure of the stoma before postoperative day 8-14, may be an alternative [3,4]. The use of a transanal tube is dubious [5,6]. Intraoperative laser M. Ellebaek (&) Á N. Qvist Odense University Hospital, Sdr.…”

mentioning

confidence: 99%

Early detection and the prevention of serious complications of anastomotic leakage in rectal cancer surgery

Ellebæk

Qvist

2013

Tech Coloproctol

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Anastomotic leakage (AL) after low anterior resection for rectal cancer is a challenging complication in rectal cancer surgery. The reported frequency is 10-20 % in most publications, irrespective of the creation of a diverting stoma. AL has both immediate and long-term consequences that affect morbidity, mortality, functional and oncological outcome.The oncological impact of AL is still under discussion. Several studies have demonstrated an increase in local recurrence rate and a decreased overall survival, while other studies have failed to demonstrate this connection. A recent study showed that AL, which required reoperation, was associated with a significantly higher local recurrence and lower overall survival rate [1].In most cases, the clinical presentation of AL is insidious with vague and uncharacteristic abdominal symptoms, which may be masked by the use of epidural analgesia. Some cases may present with extraintestinal manifestations such as atrial fibrillation or mental confusion. Thus, AL is typically not recognized until postoperative day 5-7, which in many cases means there is significant delay in diagnosis. Another explanation of delayed diagnosis might be the low diagnostic sensitivity and specificity of common clinical tests such as body temperature, C-reactive protein (CRP) concentration and leukocyte count in peripheral blood, which moreover may be obscured by other inflammatory conditions such as pneumonia, urinary tract infections and surgical site infections. The same may apply to other inflammatory parameters such as cytokines. A recent pilot study conducted by our group using a panel of 10 cytokines and 2 complement factors in patients with and without AL found that only combined changes in IL-4, IL-6 and IL-10 could accurately predict leak (submitted for publication). A study on postoperative CRP in elective abdominal surgery, published in the present issue, showed that patients with CRP \ 135 mg/L on postoperative day 3 were unlikely to develop AL. However, the sensitivity and specificity for AL of elevated values were dependent upon the duration of the elevation in the CRP concentration [2]. Regular computed tomography (CT) scan and endoscopy are other possible but less attractive investigations due to irradiation and the risk of iatrogenic anastomotic dehiscence.Early diagnosis of AL is important to reduce the negative effects on the patient's health and to increase the success rate of treatment without reoperation. Therefore, new tests for early diagnosis of AL, before the development of overt symptoms, are warranted. The problem is that the complete pathophysiological background of AL is unknown. Several factors such as ischemia, inflammation, surgical techniques, comorbidity and preoperative radiochemotherapy may be involved.It is well documented that a diverting loop ileostomy reduces the risk of serious complications due to AL such as fecal peritonitis, reoperation, prolonged morbidity, permanent stoma and death. However, a diverting loop ileostomy is not without consequences and...

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“…Esto concuerda con otras series que comunican las complicaciones luego de la cirugía por CR 18,19 . El abordaje laparoscópico en esta serie resultó un factor protector, mostrando un Odds Ratio de 0,155, es decir, 6 veces menos probabilidad de sufrir una complicación.…”

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“…Entre ellos, las pérdidas de volumen sanguíneo, necesidad de transfusión, tiempo quirúrgico, uso de ileostomía, uso de drenajes, obesidad, tabaco, edad, drenaje transrectal, etc. [18][19][20][21][23][24][25] . Entre estos, el score de ASA es uno de los factores que se menciona sistemáticamente como factor de riesgo 18,19 lo que es concordante con lo observado en este estudio.…”

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Cáncer de recto: Análisis de las complicaciones post operatorias y mortalidad de la resección radical en una serie de 10 años

Gellona

et al. 2013

Rev Chil Cir

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Rectal cancer: early postoperative morbidity and mortality after radical resection Introduction: There has been progress in surgical treatment of rectal cancer (CR) in the past decade due to a better knowledge of the disease and the adoption of new methods of preoperative staging and treatment. The aim of this report is to analyze the early postoperative morbidity and mortality in a ten year series of patients with CR submitted to radical resection. Methods: In the database of colorectal cancer patients prospectively maintained, all patients with CR submitted to curative radical resection electively between January 2000 and December 2010 were identified. Early postoperative (30 day) morbidity and mortality were described and analyzed in a multivariate analysis to identify predictive factors. Results: A total of 308 patients were included, 55.2% male with a median age of 62 years. Over two thirds of tumors were located in the mid or lower rectum. Anterior resection was performed in 83.1%, and neoadyuvant radio-chemotherapy was used in 37.7%. Overall morbidity and mortality were 13.6% and 0.3% respectively. In multivariate analysis, American Society of Anesthesiologists had an or of 3.343 (1.601-6.982) for postoperative morbidity, and laparoscopic approach 0.188 (0.054-0.649). Conclusion: The morbidity rate of this series is similar to the one observed in other studies. The ASA score is an independent risk factor for postoperative complication and the laparoscopic approach would be a protective factor. In this series, preoperative chemoradiation was not a risk factor for postoperative morbidity.

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Can Transanal Tube Placement after Anterior Resection for Rectal Carcinoma Reduce Anastomotic Leakage Rate? A Single‐institution Prospective Randomized Study

Cited by 114 publications

References 51 publications

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Early detection and the prevention of serious complications of anastomotic leakage in rectal cancer surgery

Cáncer de recto: Análisis de las complicaciones post operatorias y mortalidad de la resección radical en una serie de 10 años

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