Incidence and Mortality of Anastomotic Dehiscence Requiring Reoperation After Rectal Carcinoma Resection

Cong, Zhi-Jie; Hu, Liang‐Hao; Xing, Junjie; Bian, Zhengqian; Fu, Chuangang; Yu, Enda; Li, Zhao‐Shen; Zhong, Ming

doi:10.9738/intsurg-d-13-00059

Cited by 11 publications

(11 citation statements)

References 53 publications

(49 reference statements)

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“…AL is a clinical problem because it may cause acute peritonitis and pelvic sepsis. It may also have an adverse effect on long‐term bowel function, quality of life, cancer‐specific survival, local recurrence and rate of permanent stoma. Previous studies reported that the incidence of major AL was reduced when CJP reconstruction was performed in patients with a stapled colorectal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

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Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Pucciarelli

Bianco

Pace

et al. 2019

British Journal of Surgery

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Background Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. Methods This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. Results Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. Conclusion Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov/).

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Section: Discussionmentioning

confidence: 99%

“…Clinical AL has a negative impact on postoperative mortality, risk of permanent stoma, bowel function and quality of life. All this considered, the authors hypothesized that CJP reconstruction after LAR for rectal cancer may reduce the incidence of AL compared with the standard SCRA, and may improve bowel function and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Pucciarelli

Bianco

Pace

et al. 2019

British Journal of Surgery

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“…AL is a burden on valuable healthcare resources; the average cost of AL following AR is £17 220 [39]. It is one of the leading causes of death following rectal cancer surgery, with around 20-30% of all 30-day mortality being directly attributed to AL [7,8]. In O232 Intra-operative fluorescence angiography to prevent anastomotic leak those patients who survive AL, it is a cause of long-term morbidity, associated with poor bowel function, reduced QoL, increased risk of cancer recurrence and high rates of permanent stoma [5,6,9,40].…”

Section: Discussionmentioning

confidence: 99%

“…It increases postoperative morbidity from~20% to~60% and mortality from < 5% to~20%, and extends in-patient stay by an additional 7 days on average [2][3][4]. Patients who survive AL suffer long-term consequences with reduced quality of life (QoL), high rates of wound complications, permanent stoma and increased risk of cancer recurrence [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

IntAct: intra‐operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial

et al. 2018

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AimAnastomotic leak (AL) is a major complication of rectal cancer surgery. Despite advances in surgical practice, the rates of AL have remained static, at around 10–15%. The aetiology of AL is multifactorial, but one of the most crucial risk factors, which is mostly under the control of the surgeon, is blood supply to the anastomosis. The MRC/NIHR IntAct study will determine whether assessment of anastomotic perfusion using a fluorescent dye (indocyanine green) and near‐infrared laparoscopy can minimize the rate of AL leak compared with conventional white‐light laparoscopy. Two mechanistic sub‐studies will explore the role of the rectal microbiome in AL and the predictive value of CT angiography/perfusion studies.MethodIntAct is a prospective, unblinded, parallel‐group, multicentre, European, randomized controlled trial comparing surgery with intra‐operative fluorescence angiography (IFA) against standard care (surgery with no IFA). The primary end‐point is rate of clinical AL at 90 days following surgery. Secondary end‐points include all AL (clinical and radiological), change in planned anastomosis, complications and re‐interventions, use of stoma, cost‐effectiveness of the intervention and quality of life. Patients should have a diagnosis of adenocarcinoma of the rectum suitable for potentially curative surgery by anterior resection. Over 3 years, 880 patients from 25 European centres will be recruited and followed up for 90 days.DiscussionIntAct will rigorously evaluate the use of IFA in rectal cancer surgery and explore the role of the microbiome in AL and the predictive value of preoperative CT angiography/perfusion scanning.

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“…Anastomotic dehiscence is a complication in colorectal surgery. A recent systematic review showed that the overall rate of dehiscence was 8.6%, the rate of dehiscence requiring re-operation was 5.4%, the post-operative mortality was 0.4%, and the overall post-operative mortality was 1.3% [7]. We report a case of complete stoma dehiscence for abscess after colorectal surgery that was treated successfully using VAC therapy.…”

mentioning

confidence: 86%

Use of Vacuum-Assisted Closure in the Management of Colostomy

ZanellaSimone

LeoAlberto

2016

Surgical Infections Case Reports

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Background: This article is the first report of the simultaneous use of vacuum-assisted closure (VAC) therapy and an oral tube applied as a life-saving treatment for colostomy dehiscence to avoid fecal contamination. Case Presentation: A 75-year-old female was admitted to our surgical unit in 2012 for knee trauma caused by an accidental fall at home. Surgery for lysis of adhesions, left colectomy, colorectal anastomosis, and protective ileostomy was performed initially for sigmoidovaginal fistula. Vacuum-assisted closure therapy (applying continuous negative abdominal pressure) was used after median wound dehiscence and a parastomal abscess that caused the necrosis of the skin and subcutaneous tissue surrounding the colostomy. Conclusion: The application of a negative pressure is a novel approach to colostomy dehiscence and complicated abdominal wound management and can lead to complete abdominal wound closure and finally to apply a standard plate for colostomy bag.

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Incidence and Mortality of Anastomotic Dehiscence Requiring Reoperation After Rectal Carcinoma Resection

Cited by 11 publications

References 53 publications

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

IntAct: intra‐operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial

Use of Vacuum-Assisted Closure in the Management of Colostomy

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