Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer

Rahbari, Nuh N.; Weitz, Jürgen; Hohenberger, Werner; Heald, R. J.; Moran, Brendan; Ulrich, Alexis; Holm, Torbjörn; Wong, W. Douglas; Tiret, Emmanuel; Moriya, Yoshihiro; Laurberg, Søren; Dulk, Marcel den; Velde, Cornelis van de; Büchler, Markus W.

doi:10.1016/j.surg.2009.10.012

Cited by 1,111 publications

(867 citation statements)

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“…Anastomotic leaks were classified as being either clinical or radiological and were defined as per the International Study Group of Rectal Cancer. 17 All patients in whom an anastomosis was formed underwent a gastrograffin enema study at postoperative Day 3-5 to assess for evidence of a leak. Morbidities were captured systematically by a nurse trained in data collection.…”

Section: Discussionmentioning

confidence: 99%

Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery

Boland

Reynolds

McCawley

et al. 2017

annals

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INTRODUCTION Recent studies have advocated the use of perioperative fluid restriction in patients undergoing major abdominal surgery as part of an enhanced recovery protocol. Series reported to date include a heterogenous group of high-and low-risk procedures but few studies have focused on rectal cancer surgery alone. The aim of this study was to assess the effects of perioperative fluid volumes on outcomes in patients undergoing elective rectal cancer resection. METHODS A prospectively maintained database of patients with rectal cancer who underwent elective surgery over a 2-year period was reviewed. Total volume of fluid received intraoperatively was calculated, as well as blood products required in the perioperative period. The primary outcome was postoperative morbidity (Clavien-Dindo grade I-IV) and the secondary outcomes were length of stay and major morbidity (Clavien-Dindo grade III-IV). RESULTS Over a 2-year period (2012-2013), 120 patients underwent elective surgery with curative intent for rectal cancer. Median total intraoperative fluid volume received was 3680ml (range 1200-9670ml); 65/120 (54.1%) had any complications, with 20/120 (16.6%) classified as major (Clavien-Dindo grade III-IV). Intraoperative volume >3500ml was an independent risk factor for the development of postoperative all-cause morbidity (P=0.02) and was associated with major morbidity (P=0.09). Intraoperative fluid volumes also correlated with length of hospital stay (Pearson's correlation coefficient 0.33; P<0.01). CONCLUSIONS Intraoperative fluid infusion volumes in excess of 3500ml are associated with increased morbidity and length of stay in patients undergoing elective surgery for rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery

Boland

Reynolds

McCawley

et al. 2017

annals

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“…The most serious complications of reconstructive surgery of the gastrointestinal tract include leaking anastomosis. This is a serious, life-threatening complication, and -according to data from reference colorectal surgery centres -concerns 9-13% of patients (6,7,8). The failure of anal sphincters is a complication which is not a direct threat to the patient's life, yet it decisively reduces its quality and the ability to function properly in society.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of anorectal manometry in patients with a stoma before and after surgery to restore the continuity of the gastrointestinal tract

Zieliński¹,

Czyżewski²,

Szczepkowski³

2016

Polish Journal of Surgery

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The operation to restore the continuity of the gastrointestinal tract is another surgical intervention in a given patient, which directly translates into an increased risk of complications during and after surgery. That is why proper qualification is important for the operation to restore the continuity of the gastrointestinal tract in terms of performance and efficiency of the anal sphincter apparatus, among other things. The aim of the study was to evaluate the effect of restoring physiological defecation routes on the sphincter function and to observe the parameters of anorectal manometry in patients before and after surgery to restore the continuity of the gastrointestinal tract. material and methods. The study included 29 patients scheduled for restoration of the continuity of the gastrointestinal tract, 12 women and 17 men. The average age in the group was 62 years. Anorectal manometry was performed both before surgery as well as one month and three months afterwards in all patients. The average time to have a stoma was 12 months. Results. The resting pressure in the anal canal (MRP) three months after the restoration of the continuity of the gastrointestinal tract increased by 30.4%. The maximum systolic blood pressure in the anal canal (MSP) increased by 22.2%. The value of recto-anal inhibitory reflex (RAIR) decreased by 19.2%. The length of the high pressure zone in the anal canal (HPZL) increased by 27%. The study results of visceral rectal sensation thresholds decreased by 23.3% for the sensation threshold, and 14.4% for the pressure threshold. conclusions. Restoring the continuity of the gastrointestinal tract improves the anal sphincter function which is evident in the parameters of anorectal manometry. The restoration of passage improves the sphincter function, and these changes are statistically significant.

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“…Nonetheless, anastomotic leakage remains one the most significant complications after LAR. Anastomotic leakage is defined as a communication between the intraand extraluminal compartments owing to a defect in the integrity of the intestinal wall at the anastomosis between the colon and rectum or the colon and anus [2] . In the last decade, the problem of anastomotic leakage has been widely addressed in multiple symposia and many publications [3] .…”

Section: Introductionmentioning

confidence: 99%

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

Wu¹,

Ma²,

Yu³

2014

WJG

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AIM:To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer. METHODS:The PubMed, EMBASE, and MEDLINE databases were searched for studies and relevant literature published between 2007 and 2014 regarding the construction of a protective stoma during LAR. A pooled risk ratio (RR) with 95% confidence intervals (CIs) was used to assess the outcomes of the studies, including the rate of postoperative anastomotic leakage and reoperations related to leakage. Funnel plots and Egger's tests were used to evaluate the publication biases of the studies. P values < 0.05 were considered statistically significant. RESULTS:A total of 11 studies were included in the meta-analysis. In total, 5612 patients were examined, 2868 of whom had a protective stoma and 2744 of whom did not. The sample size of the studies varied from 34 to 1912 patients. All studies reported the number of patients who developed an anastomotic leakage and required a reoperation related to leakage. A random effects model was used to calculate the pooled RR with the corresponding 95%CI because obvious heterogeneity was observed among the 11 studies (I 2 = 77%). The results indicated that the creation of a protective stoma during LAR significantly reduces the rate of anastomotic leakage and the number of reoperations related to leakage, with pooled RRs of 0.38 (95%CI: 0.30-0.48, P < 0.00001) and 0.37 (95%CI: 0.29-0.48, P < 0.00001), respectively. The shape of the funnel plot did not reveal any evidence of obvious asymmetry. CONCLUSION:The presence of a protective stoma effectively decreased the incidences of anastomotic leakage and reoperation and is recommended in patients undergoing low rectal anterior resections for rectal cancer.

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Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer

Cited by 1,111 publications

References 93 publications

Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery

Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery

The usefulness of anorectal manometry in patients with a stoma before and after surgery to restore the continuity of the gastrointestinal tract

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

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