Outcome of patients with rectal cancer treated by stapled anterior resection

Belli, Luca; Beati, C.; Frangi, M.; Aseni, Paolo; Rondinara, G. F.

doi:10.1002/bjs.1800750509

Cited by 27 publications

(4 citation statements)

References 16 publications

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“…It has been theorized that stapled anastomosis may predispose to local recurrence by causing lntraluminal trauma, spilling tumor cells into the pelvis, imglanting tumor cells at the staple line, or delaying healing [8]. Sia~reports have shown comparable local recurrence rates in ha~ tea versus hand-sewn techniques [4,[9][10][11] while others t3]. ~ SUggested increased recurrence in stapled patients [12, The reason for variance in local recurrence in some non-~aonnd°mized series may relate to variables affecting case selec-…”

Section: Discussionmentioning

confidence: 99%

Results of the double stapling procedure in pelvic surgery

1992

World j. surg.

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The double stapling technique for rectal reconstruction after resection involves closing the lower rectal segment with a linear stapler and performing the anastomosis using a circular stapler across the linear staple row. The purpose of this report is to review the results of double stapling, present our experience, and draw conclusions from the material available. We have utilized the double stapling technique in 80 patients for primary anastomoses and in 11 patients for secondary anastomoses following Hartmann procedures. Twenty-one anastomoses were at or near the dentate line. Fifty-six patients had rectal carcinoma, 29 patients had diverticulitis, 3 patients had carcinoma of the ovary, and 1 patient each had traumatic rectal perforation, volvulus, or rectal prolapse. Complications in the total 91 patients included 3 anastomotic leaks (3.3%), 1 postoperative hemoperitoneum (1.1%), and 3 strictures (3.3%). No anastomosis was protected by diverting colostomy. There were no operative deaths. Of 43 patients with cancer available for follow-up, 4 patients have developed local recurrence. The technique has been modified for ileoanal anastomosis during abdominal restorative proctocolectomy for ulcerative colitis and familial polyposis and early results are favorable. The double stapling technique provides a safe method for rectal reconstruction at or near the dentate line and offers the following advantages over other stapler techniques: (1) It eliminates the frustrating distal pursestring; (2) The rectal segment is not opened, minimizing contamination; and (3) It avoids gathering the sometimes generous circumference of the rectum on a pursestring thus allowing a more precise distal donut.

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Section: Discussionmentioning

confidence: 99%

Results of the double stapling procedure in pelvic surgery

1992

World j. surg.

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“…The main reasons for this discrepancy are the technical diffi culties in accessing these areas and their easily compromised blood supply. The incidence of clinically signifi cant leakage after low anterior resection (LAR) varies between 3% and 21%, [1][2][3][4][5][6][7][8][9][10][11][12][13] but is thought to average 10%. Subclinical anastomotic failure may occur in up to 51% of patients.…”

Section: Introductionmentioning

confidence: 99%

Anastomotic leakage after low anterior resection for rectal cancer: Facts, obscurity, and fiction

2009

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The subject of anastomotic leakage after low anterior resection (LAR) for rectal cancer remains controversial. Risk factors have been discussed in several studies but the findings are often inconclusive. This review evaluates these studies and separates the known risk factors into those that are well documented, those that are obsolete, and those that require further research. We searched the Medline and PubMed databases using the keywords: "leakage," "low anterior resection," "rectal cancer," "risk factors," and their combinations. There were no language or publication year restrictions. References in published papers were also reviewed. Each risk factor was evaluated and discussed separately. The evidence suggests that low anastomoses are more prone to leakage. Other well-documented risk factors are male sex, smoking, and preoperative malnutrition. Routine mobilization of the splenic flexure and the use of a J-pouch seem to reduce the leakage rate. The effect of preoperative chemo-radiotherapy is under scrutiny. The indications for a protective stoma remain debatable. Omentoplasty, bowel preparation, the use of a drain, and tumor stage do not seem to affect the leakage rate. The type of operation (open or laparoscopic) and anastomosis (hand-sewn or stapled) is not crucial.

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“…The reported clinical leakage rate after anterior resection varies from 3% to 21% [1][2][3][4][5][6][7][8][9][10][11][12][13] and usually results in serious morbidity requiring emergency surgery. The reported clinical leakage rate after anterior resection varies from 3% to 21% [1][2][3][4][5][6][7][8][9][10][11][12][13] and usually results in serious morbidity requiring emergency surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Anastomotic dehiscence is one of the most feared and serious early complications following any rectal anastomosis and continues to pose a major clinical problem. The reported clinical leakage rate after anterior resection varies from 3% to 21%[1–13] and usually results in serious morbidity requiring emergency surgery. Furthermore, postoperative mortality associated with anastomotic complications ranges from 6% to 22%[1,8,10–12] and accounts for approximately one third of all deaths following colorectal surgery.…”

Section: Introductionmentioning

confidence: 99%

Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection

2003

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Anastomotic dehiscence is a serious, life-threatening complication of any rectal anastomosis and may be associated with an increased risk of local cancer recurrence. The leak rate following low anterior resection is in the region of 10% as supported by the recent randomised Dutch rectal cancer trial. Although accurate prediction of risk is impossible, certain factors are known to influence leak rates. There is an inverse relationship between the height of anastomoses from the anal verge and leak rate, with the lower anastomoses carrying the highest risk. Proximal defunctioning mitigates the consequences of leakage but does not abolish risk. There is little difference in rates of dehiscence between stapled and sutured colorectal anastomoses. A short colon pouch may reduce the chance of leakage. The highest risks are in unprotected anastomoses less than 5 cm from the anal verge in men who smoke and/or drink excessively, particularly if they have received pre-operative chemotherapy or chemo-radiotherapy. A high index of suspicion is required in detecting the early nonspecific signs of a leak and urgent surgical intervention is usually required to avert a life-threatening situation. Judicious use of faecal diversion should never be regarded as surgical timidity.

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Outcome of patients with rectal cancer treated by stapled anterior resection

Cited by 27 publications

References 16 publications

Results of the double stapling procedure in pelvic surgery

Results of the double stapling procedure in pelvic surgery

Anastomotic leakage after low anterior resection for rectal cancer: Facts, obscurity, and fiction

Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection

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