Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

Wang, Zhijie; Tao, Jinhua; Chen, Jianan; Mei, Shiwen; Shen, Huan; Zhao, Fen; Liu, Qian

doi:10.4251/wjgo.v11.i7.538

Cited by 8 publications

(12 citation statements)

References 38 publications

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“…Recent studies have reported that the AL rate after rectal cancer surgery is 3% to 26%[ 10 - 12 ]. The occurrence of AL prolongs hospitalization time, increases the economic and mental burden for patients and increases short-term morbidity and mortality[ 13 , 14 ]. Poor blood supply is an important factor in AL.…”

Section: Introductionmentioning

confidence: 99%

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Chen

Liu

Wang

et al. 2020

WJGO

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BACKGROUND For laparoscopic rectal cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin from the aorta [high ligation (HL)] or distally to the origin of the left colic artery [low ligation (LL)]. Whether different ligation levels are related to different postoperative complications, operation time, and lymph node yield remains controversial. Therefore, we designed this study to determine the effects of different ligation levels in rectal cancer surgery. AIM To investigate the operative results following HL and LL of the IMA in rectal cancer patients. METHODS From January 2017 to July 2019, this retrospective cohort study collected information from 462 consecutive rectal cancer patients. According to the ligation level, 235 patients were assigned to the HL group while 227 patients were assigned to the LL group. Data regarding the clinical characteristics, surgical characteristics and complications, pathological outcomes and postoperative recovery were obtained and compared between the two groups. A multivariate logistic regression analysis was performed to evaluate the possible risk factors for anastomotic leakage (AL). RESULTS Compared to the HL group, the LL group had a significantly lower AL rate, with 6 (2.8%) cases in the LL group and 24 (11.0%) cases in the HL group ( P = 0.001). The HL group also had a higher diverting stoma rate (16.5% vs 7.5%, P = 0.003). A multivariate logistic regression analysis was subsequently performed to adjust for the confounding factors and confirmed that HL (OR = 3.599; 95%CI: 1.374-9.425; P = 0.009), tumor located below the peritoneal reflection (OR = 2.751; 95%CI: 0.772-3.985; P = 0.031) and age (≥ 65 years) (OR = 2.494; 95%CI: 1.080-5.760; P = 0.032) were risk factors for AL. There were no differences in terms of patient demographics, pathological outcomes, lymph nodes harvested, blood loss, hospital stay and urinary function ( P > 0.05). CONCLUSION In rectal cancer surgery, LL should be the preferred method, as it has a lower AL and diverting stoma rate.

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Section: Introductionmentioning

confidence: 99%

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Chen

Liu

Wang

et al. 2020

WJGO

Self Cite

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“…A total of 4 studies involving 4 trials were identified for inclusion in the review [ 3 , 4 , 8 , 9 ]. The search of PubMed, Embase, and Cochrane Library databases provided a total of 195 citations.…”

Section: Resultsmentioning

confidence: 99%

“…In Wang et al's study [ 4 ], totally 171 patients received IC wh , mainly 157 were treated with fluorouracil implants alone, and another 14 were treated with lobaplatin or both. According to the same period and same institution about IC wh with lobaplatin, data presented that only 2% (1/50) had anastomotic leakage; we regard this set of data as the use of fluorouracil only and then combine with the data in Yuan et al's [ 3 ] study to analyze the relationship between the use of fluorouracil implanted into the abdominal cavity as IC wh and the occurrence of AL after colorectal cancer surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely used, but based on advantages of straightforward operation and good tolerance, intraperitoneal chemotherapy without hyperthermia (IC wh ) has become one of the important means of comprehensive treatment of colorectal cancers under the concept of enhanced recovery after surgery (ERAS). Regarding the relationship between IC wh and postoperative complications, especially the occurrence of anastomotic leakage (AL), the results of different studies are not consistent [ 3 , 4 ]. Therefore, the main purpose of this meta-analysis is to provide better evidence for whether IC wh increases the incidence of anastomotic leakage after colorectal cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

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Does Intraperitoneal Chemotherapy Increase the Incidence of Anastomotic Leakage after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

2021

Gastroenterology Research and Practice

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Purpose. To identify and evaluate the influence of intraperitoneal chemotherapy without hyperthermia (ICwh) to the incidence of anastomotic leakage (AL) after colorectal cancer surgery. Methods. A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses in order to review all studies investigating the relationship between ICwh and AL in patients undergoing colorectal surgery. The primary outcome was overall incidence rate of anastomotic leakage. Results. Four studies were included in the final review. ICwh was associated with an overall increased risk of anastomotic leakage [OR 2.05 (1.06, 3.98), P = 0.03 ]. But there was no significant increased incidence rate when fluorouracil was implanted into the abdominal cavity for ICwh [OR 2.48 (0.55, 11.10), P = 0.24 ]. Conclusions. This meta-analysis provides some evidence to suggest ICwh may increase the incidence of postoperative AL in colorectal cancer. However, fluorouracil implantation for ICwh does not increase the risk of AL, which seems to be a relatively safe method of ICwh.

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“…However, many surgeons hold the view that further prolongation of the time interval to surgery will increase the risk of the operation because pelvic fibrosis caused by radiotherapy may lead to intraoperative or postoperative bleeding. According to our previous research, intraperitoneal chemotherapy can lead to postoperative anastomotic leakage, especially in patients undergoing preoperative neoadjuvant therapy[ 34 ]. In fact, Stein et al[ 35 ] reported that in the shorter interval group, the incidence of complications was higher than that in the longer time interval group.…”

Section: Discussionmentioning

confidence: 99%

Impact of interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients

Mei

Liu

Wei

et al. 2020

WJG

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BACKGROUND Epidemiologically, in China, locally advanced rectal cancer is a more common form of rectal cancer. Preoperative neoadjuvant concurrent chemoradiotherapy can effectively reduce the size of locally invasive tumors and improve disease-free survival (DFS) and pathologic response after surgery. At present, this modality has become the standard protocol for the treatment of locally advanced rectal cancer in many centers, but the optimal time for surgery after neoadjuvant therapy is still controversial. AIM To investigate the impact of time interval between neoadjuvant therapy and surgery on DFS and pathologic response in patients with locally advanced rectal cancer. METHODS A total of 231 patients who were classified as having clinical stage II or III advanced rectal cancer and underwent neoadjuvant chemoradiation followed by surgery at the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from November 2014 to August 2017 were involved in this retrospective cohort study. The patients were divided into two groups based on the different time intervals between neoadjuvant therapy and surgery: 139 (60.2%) patients were in group A (≤ 9 wk), and 92 (39.2%) patients were in group B (> 9 wk). DFS and pathologic response were analyzed as the primary endpoints. The secondary endpoints were postoperative complications and sphincter preservation. RESULTS For the 231 patients included, surgery was performed at ≤ 9 wk in 139 (60.2%) patients and at > 9 wk in 92 (39.8%). The patients’ clinical characteristics, surgical results, and tumor outcomes were analyzed through univariate analysis combined with multivariate regression analysis. The overall pathologic complete response (pCR) rate was 27.2% ( n = 25) in the longer time interval group (> 9 wk) and 10.8% ( n = 15) in the shorter time interval group (≤ 9 wk, P = 0.001). The postoperative complications did not differ between the groups (group A, 5% vs group B, 5.4%; P = 0.894). Surgical procedures for sphincter preservation were performed in 113 (48.9%) patients, which were not significantly different between the groups (group A, 52.5% vs group B, 43.5%; P = 0.179). The pCR rate was an independent factor affected by time interval ( P = 0.009; odds ratio [OR] = 2.668; 95%CI: 1.276-5.578). Kaplan-Meier analysis and Cox regression analysis showed that the longer time interval (> 9 wk) was a significant independent prognostic factor for DFS ( P = 0.032; OR = 2.295; 95%CI: 1.074-4.905), but the time interval was not an independent prognostic factor for overall survival ( P > 0.05). CONCLUSION A longer time interval to sur...

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Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

Cited by 8 publications

References 38 publications

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

Does Intraperitoneal Chemotherapy Increase the Incidence of Anastomotic Leakage after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Impact of interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer patients

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