Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

Borly, Lars; Ellebæk, Mark Bremholm; Qvist, Niels

doi:10.1155/2015/376540

Cited by 4 publications

(2 citation statements)

References 13 publications

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“…Anastomotic leakage (AL) after colorectal restaurative surgery is a major complication with direct impact on morbidity and mortality. Studies have shown an anastomotic leakage rate of 4-45% (20,21,22,23,24), with significant mortality of 6-22% (23,24).…”

Section: Discussion Discussionmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Aslan¹,

Grama²,

Cristian³

et al. 2016

chr

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The purpose of this article is to identify the risk factors for local recurrence and anastomotic leakage after sphincter-sparing surgery for low and mid rectal cancer. Material and We prospectively analyzed a group of 38 patients with low and middle rectal cancer who underwent sphincter-sparing surgery. Low anterior resection was performed in 32 cases (84.2%) and 6 cases (15.8%) benefited of ultralow anterior resection. Clinical stadialization cTNM included 3 patients (7.9%) T1 stage, 11 patients (28.9%) T2 stage and 24 patients (63.2%) T3 stage. Preoperative radiotherapy was performed in 33 cases (86.4%), and chemotherapy was associated in 20 cases (52.6%). The stages I and II cancers were prevalent (63.2%), followed by stage III cancers (23.7%) and stage IV cancers (13.2%). The rate of complications of 52.6% (20 cases) was associated with T3 stage cancers. Anastomotic leakage has occurred in 4 cases (10.5%) and tumor recurrence has developed in 3 cases (7.9%). The rate of local recurrence and anastomotic leakage is associated with the number of positive lymph nodes (more than 4 nodes, 5.3%, p = 0.023). We found no association between chemoradiotherapy and the risk of local recurrence (p 0.05). Other postoperative complications included intestinal obstruction by adhesions or bowel volvulus (5 cases, 13.2%), postradiation colitis (3 cases, 7.7%), coloanal anastomotic stenosis (1 case, 2.6%), rectovaginal fistula (1 case, 2.6%), ileostomy bleeding (1 case, 2.6%), wound infection (2 cases, 5.3%). Risk factors associated with local recurrence and anastomotic leakage are aggressive stage tumor, lymphnodes involvement, neoadjuvant therapy and postoperative anemia. The postoperative outcome was favorable after sphincter preservation surgery and the absence of definitive colostomy had an important impact on the quality of life of the patients with distal rectal cancer.

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Section: Discussion Discussionmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Aslan¹,

Grama²,

Cristian³

et al. 2016

chr

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show abstract

“…1–3 Anastomotic leakage leads to a series of infection-related complications and accounts for up to a third of all fatalities after rectal cancer surgery. 4 When faced with an anastomotic leakage, many surgeons prefer intestinal bypass surgery, including temporary and permanent intestinal bypass surgery, for immediate control of infection. 5 , 6 However, regardless of the surgical method, the patient will experience the negative impact of the second operation and its related complications.…”

Section: Introductionmentioning

confidence: 99%

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study

Zhang¹,

Hu²,

Qin³

et al. 2022

CMAR

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Purpose To determine an accurate method of inspecting low anastomotic leakages and application of transurethral prostate resection instrumentation for treating low rectal anastomotic leakage. Patients and Methods Clinical data of eight patients treated for anastomotic leakage after rectal cancer surgery at Zhangye People’s Hospital (affiliated to Hexi University), from August 2019 to November 2021, were retrospectively analyzed. Transanal prostate resection instrumentation was used to assess the leakage and surrounding conditions. Using prostate resection instrumentation, the presacral and perirectal residual cavities were washed and removed, and indwelling suprapubic presacral, transanal presacral, and rectal drainage tubes were placed. Continuous presacral saline irrigation and drainage and open negative-pressure suction in the rectal cavity were performed until the patients’ fistula healed. Results Of the eight patients with anastomotic leakages, one had grade B and seven had grade C International Study Group of Rectal Cancer anastomotic leakage classifications following Dixon operation. Transanal prostate resection instrumentation showed that the leakage of the one patient with grade B was less than a third of the circumference of the anastomosis. Among the seven patients with grade C, one leakage was less than a third of the anastomotic circumference. One patient had complete separation of the anastomosis and one distal colon necrosis, which necessitated immediate descending colostomy. Conservative treatment was successful in six patients; the conservative overall cure rate was 75%, and the median healing time was 43 (21–68) days. Conclusion Transanal examination of rectal anastomotic leakage using prostate resection instrumentation is comprehensive, easy to perform, provides clear visualization, accurately guides catheter placement, and can be combined with continuous open negative-pressure drainage, which is a safe, convenient, and effective method for treating low rectal leakage.

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Mucosa plication reinforced colorectal anastomosis and trans-anal vacuum drainage: a pilot study with preliminary results

et al. 2021

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Dehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019–October 2020. The mean age of patients was 61 years (lower–upper quartiles 54–69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower–upper quartiles 3.00–4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien–Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

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Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

Cited by 4 publications

References 13 publications

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Sphincter-Sparing Surgery in Patients with Mid and Low Rectal Cancer - Risk Factors for Local Recurrence and Anastomotic Leakage

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study

Mucosa plication reinforced colorectal anastomosis and trans-anal vacuum drainage: a pilot study with preliminary results

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