Long-Term Results after Anastomotic Leakage following Rectal Cancer Surgery: A Comparison of Treatment with Endo-Sponge and Transanal Irrigation

Abstract

We aimed to evaluate long-term results in patients from regular health care treated with endoscopic transanal closure system, that is, endoscopic vacuum-assisted closure system (EVAC) compared to transanal irrigation. Methods: In this retrospective, medical chart-based, observational study, we included patients with anastomotic leakage after low anterior resection for rectal cancer from 3 Stockholm hospitals 2006-2016 and compared time to first stoma closure in a Kaplan-Meier model and the proportion of patients who were stoma-free at end of follow-up. Results: Anastomotic leakage was found in 81 patients who were followed up in median 5.9 years (min-max: 0.53-13). EVAC was used on 14 (17%) patients and transanal irrigation on 34 (42%) patients. The remaining 33 (41%) patients either got a permanent colostomy or were treated only with antibiotics and percutaneous drainage. Treatment with EVAC or transanal irrigation led to similar rates of stoma closure, both when comparing all patients, and when comparing patients with similar defects. At the end of follow-up, 43% of patients treated with EVAC and 50% of patients treated with repeated irrigation were stoma-free (p = 0.75). Conclusions: We found no evidence of better outcomes in patients treated with EVAC. The study was, however, limited by small sample size.

Endoscopic vacuum therapy for the treatment of colorectal leaks — a systematic review and meta-analysis

“…6). Anastomotic stenosis accounted for the most frequent complication after EVT in n = 24 (0 up to 18.2% [18]) reported cases, followed by fistulas n = 17 (0 up to 28.6% [24]), abscess formation and chronic sinus (presacral abscess Fig. 3 Forest plot for success rate of EVT across the studies.…”

“…The studies were from the following countries of origin: Italy (n = 6), Germany (n = 5), Netherlands (n = 5), Denmark (n = 2), Spain (n = 1), Sweden (n = 1), Austria (n = 1), Turkey (n = 1), USA (n = 1), France (n = 1). These publications comprise 18 retrospective studies [3,8,9,[12][13][14][15][16][17][18][23][24][25][26][27][28][29] and 6 prospective studies [10,11,[19][20][21][22]. Due to the lack of data from RCTs, a few prospective and mostly retrospective case series on EVT treatment of colorectal defects were included in this systematic review.…”

Effect of Placing Double-lumen Irrigation-suction Tube on Spontaneous Closure of Anastomotic Leakage Following Rectal Cancer Surgery

“…In addition, removal of the infection was another important factor for spontaneous closure. This may be why EVAC seemed to have no obvious advantage compared with transanal drainage in Weréen's study [11]. In our study, the spontaneous closure rate was about 60% when using DLIST.…”

“…However, the rates were variable in different studies [21]. A Swedish study investigating a certain number of patients [11], showed that the general spontaneous closure rate seemed to be only about 50%-60% when using the EVAC and transanal irrigation. In theory, EVAC microstructure could have a better effect on forming granulation tissue and promoting granulation tissue shrinkage [18].…”

“…In few selected patients, the two methods,transanal drainage and endoscopic vacuum-assisted closure, elevated the spontaneous closure rate as high as 90% [9,10]. However, in a recent study involving more patients, it was shown that the 2-year spontaneous closure rate using the two new methods was only about 50% [11]. In short, treatment aimed at spontaneous closure of rectal AL is still relatively di cult and worthy of exploration.…”