Impact of anastomotic leakage on oncological outcome after rectal cancer resection

Ptok, H.; Marusch, F.; Meyer, Frank; Schubert, Daniel; Gastinger, I.; Lippert, H.

doi:10.1002/bjs.5707

Cited by 179 publications

(142 citation statements)

References 32 publications

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“…In general, the global, clinical judgement seems to localize a subset of patients at risk for developing complications in general, whereas many patients with no risk factors at all may develop anastomotic leakage [12]. The risk factors for anastomotic leakage identified by univariate and multivariate analysis in our study corroborate with those found in other studies [1][2][3][4][5][6][7][8]. Similar to these studies, the number of risk factors present in an individual patient appeared to be an important predictor of anastomotic leakage in all anastomoses.…”

Section: Discussionsupporting

confidence: 88%

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Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

387

239

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Background The dramatic clinical consequences of anastomotic leakage in gastrointestinal surgery can be reduced by a diverting stoma or drainage of the peri-anastomotic area. Currently, the surgeons' clinical judgement is of major importance in decision making, but reliable data of the diagnostic accuracy are lacking. In this prospective clinical study, the surgeons' predictive accuracy for anastomotic leakage was evaluated. Materials and methods In 191 patients undergoing colorectal resection with anastomosis, the risk for anastomotic leakage was determined by the surgeon on the basis of a visual analogue scale (VAS). This risk assessment was compared to the actual occurrence of anastomotic leakage post-operatively. Results A total of 26 (13.6%) patients showed anastomotic leakage. The surgeons' median predicted leakage rate was 7.1% in anastomoses >15 cm from the anal verge and 9.5% ≤15 cm (sensitivity 38/62%, specificity 46/52%). Diagnostic accuracy was not influenced by the surgeons' training level (VAS score, surgeons 7.8% vs assistant surgeons 8.5%, p=0.96, sensitivity 41% vs 44%, specificity 59% vs 48%, p=0.20). Conclusion The surgeons' clinical risk assessment appeared to have a low predictive value for anastomotic leakage in gastrointestinal surgery. The low a priori risk of anastomotic leakage of 14% resulted in a low post-test odds (11%) of correct prediction of anastomotic leakage. This warrants the ongoing search for a better diagnostic test of anastomotic leakage to prevent morbidity and mortality.

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Section: Discussionsupporting

confidence: 88%

“…Gastrointestinal anastomotic leakage causes increased early mortality [1] and, following potentially curative resection of colorectal cancer, leads to higher recurrence rates and a poorer oncologic prognosis [2]. Clinically relevant anastomotic leakage rates range between 3% and 19% [1,[3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

387

239

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“…Leakage can increase morbidity and mortality, prolong the duration of the hospital stay, and affect short-or long-term quality of life [7,8] . There is also evidence for an increased risk of local cancer recurrence and decreased long-term survival after leakage [9][10][11] . Many solutions have been sought to prevent or diminish anastomotic leakage, such as mechanical bowel preparation, drains, and intra-luminal devices.…”

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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“…Así, Bennis et al 23 , en pacientes con resección anterior baja y anastomosis coloanal, observaron que los pacientes de sexo masculino poseían un OR de 1,8 para morbilidad global y 2,3 para complicación médica. Por su parte, Ptok et al 24 , al analizar, sexo como factor de riesgo para filtración de anastomosis, encontraron que los pacientes de sexo masculino tenían una tasa de filtración más alta. Otros autores han encontrado resultados similares [25][26][27] .…”

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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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Impact of anastomotic leakage on oncological outcome after rectal cancer resection

Abstract: : A negative prognostic impact of anastomotic leakage on local recurrence and disease-free survival was found only for patients with leakage needing surgical revision.

Cited by 179 publications

References 32 publications

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

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

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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