Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience

Boyce, Stephen; Harris, Chas. K.; Stevenson, Andrew; Lumley, John W.; Clark, David

doi:10.1097/dcr.0000000000000822

Cited by 68 publications

(72 citation statements)

References 34 publications

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“…The management of AL is challenging [8][9][10][11]. Traditionally, surgical resection of the anastomosis with proximal stoma formation has been the treatment of choice.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection

et al. 2019

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Aim Management of anastomotic leakage (AL) following rectal resection has evolved with increasing use of less invasive techniques. The aim of this study was to review the management of AL following restorative rectal cancer resection in a tertiary referral centre. Method A retrospective review of a prospectively maintained database was performed. The primary outcome was successful management of AL. The secondary outcome was the impact of AL on oncological outcome. Results Five hundred and two restorative rectal cancer resections were performed during the study period. The incidence of AL was 9.9% (n = 50). AL occurred more commonly following neoadjuvant chemoradiotherapy (n = 31/252, 12.3%) than in those who did not receive neoadjuvant chemoradiotherapy (n = 19/250, 7.6%; P = 0.107); however, this was not statistically significant. Successful minimally invasive drainage was achieved in 28 patients (56%, radiological n = 24, surgical n = 4). Trans‐rectal drainage was the most common drainage method (n = 14). The median duration of drainage was longer in the neoadjuvant group (27 vs 18 days). Surgical intervention was required in 11 patients, with anastomotic takedown and end‐colostomy formation was most commonly required. Successful management of AL with drainage (maintenance of the anastomosis without the need for further intervention) was achieved in 26 of the 28 patients. There were no significant differences in overall or disease‐free survival when patients with AL were compared with patients without AL (69.4% vs 72.6%, P = 0.99 and 78.7% vs 71.3%, P = 0.45, respectively). Conclusion In selected patients, AL following restorative rectal resection can be effectively controlled using minimally invasive radiological or surgical drainage without the need for further intervention.

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“…The management of AL is challenging [8][9][10][11]. Traditionally, surgical resection of the anastomosis with proximal stoma formation has been the treatment of choice.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection

et al. 2019

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“…Approximately 1.5% of surgical procedures performed in Wisconsin are complicated by SSIs, and the Centers for Disease Control and Prevention (CDC) reports that mortality associated with SSIs has been reported to be as high as 3% nationally . Specific case scenarios (ie, organ or body space infections after laparoscopic colorectal surgeries in which anastomotic leaks occurred) have been associated with a 30‐day mortality rate of 4.5% . Furthermore, the fiscal burden of these adverse events approaches $10 billion annually in the United States .…”

mentioning

confidence: 99%

Implementation of a Wisconsin Division of Public Health Surgical Site Infection Prevention Champion Initiative

Borlaug¹,

Edmiston²

2018

AORN Journal

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Approximately 900 surgical site infections (SSIs) were reported to the Wisconsin Division of Public Health annually from 2013 to 2015, representing the most prevalent reported health care-associated infection in the state. Personnel at the Wisconsin Division of Public Health launched an SSI prevention initiative in May 2015 using a surgical care champion to provide surgical team peer-to-peer guidance through voluntary, nonregulatory, fee-exempt onsite visits that included presentations regarding the evidence-based surgical care bundle, tours of the OR and central processing areas, and one-on-one discussions with surgeons. The surgical care champion visited 10 facilities from August to December 2015, and at those facilities, SSIs decreased from 83 in 2015 to 47 in 2016 and the overall SSI standardized infection ratio decreased by 45% from 1.61 to 0.88 (P = .002), suggesting a statewide SSI prevention champion model can help lead to improved patient outcomes.

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“…Permanent stoma occurred in 1.8% of our patients, or one‐third of patients with AC, whether AL or AS. The incidence of permanent stoma after transient diversion is reported to range from 3% to 60% . Restoration failure in patients with AL was due mostly to recurrences and intractable pelvic inflammation, whereas restoration failure in patients with AS was due mostly to recurrences and obstinate stenosis …”

Section: Discussionmentioning

confidence: 99%

“…The incidence of permanent stoma after transient diversion is reported to range from 3% to 60%. 26,27 Restoration failure in patients with AL was due mostly to recurrences and intractable pelvic inflammation, whereas restoration failure in patients with AS was due mostly to recurrences and obstinate stenosis. 27 We found that AL as an independent risk factor for DFS, as reported in many previous studies and meta-analyses, 3,28,29 although a recent study did not find any correlation between AL and poor survival outcome in patients who received preoperative CRT.…”

Section: Discussionmentioning

confidence: 99%

Mechanotechnical faults and particular issues of anastomotic complications following robot‐assisted anterior resection in 968 rectal cancer patients

Kim

Lee

Kim

et al. 2019

Journal of Surgical Oncology

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Background As most risk factors for anastomotic complications (AC) in rectal cancer patients appear to be noncorrectable, it is needed to find the correctable causes. Additionally, the outcomes of indocyanine‐green fluorescence imaging (IFI) and robot‐stapled anastomosis have yet been undetermined. Methods This study retrospectively analyzed 968 consecutive patients with rectal cancer, who underwent curative robot‐assisted anterior resections between 2010 and 2018. IFI parameters and stapling features in the surgical records were reviewed, and reconfirmed. Results AC occurred in 54 patients (5.6%), 34 (3.5%) with anastomotic leakage (AL) and 24 (2.5%) with anastomotic stenosis (AS). Mechanotechnical faults including defective stapling configurations, including angles lesser than or equal to 150° and outer deviation (more than half from the center of the circle) of linear staples, between the two linear staples were independently associated with AL (P < .001 each). IFI significantly reduced AL rate (2.5% vs 5.3%, P = .029) and AS rate (2% vs 18.8%, P = .006), respectively. Robot linear stapling enabled to maintain the obtuse angle during consecutive staplings and reduced console time. AL and AS were independent risk factors for disease‐free survival (P = .02) and local recurrence (P = .03), respectively. Conclusions AC were associated with some correctable causes, namely, mechanotechnical errors and lack of use of IFI.

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Management of Low Colorectal Anastomotic Leakage in the Laparoscopic Era: More Than a Decade of Experience

Cited by 68 publications

References 34 publications

Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection

Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection

Implementation of a Wisconsin Division of Public Health Surgical Site Infection Prevention Champion Initiative

Mechanotechnical faults and particular issues of anastomotic complications following robot‐assisted anterior resection in 968 rectal cancer patients

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