Predicting the Risk of Anastomotic Leakage in Left-sided Colorectal Surgery Using a Colon Leakage Score

Dekker, Jan Willem T.; Liefers, G.J.; Otterloo, J. C. A. De Mol Van; Putter, Hein; Tollenaar, Rob A.E.M.

doi:10.1016/j.jss.2010.11.004

Cited by 113 publications

(150 citation statements)

References 63 publications

(22 reference statements)

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“…This can be explained by its high incidence and negative impact on the health of the patient (increased morbidity and mortality rates, length of hospital stay, risk of permanent ostoma, poor prognosis in cancer patients, damage on quality of life) and on the socioeconomic status of the population (increased health costs and workplace absence) 25 . So far, there is no technique or cost-effective method for predicting the occurrence of colorectal anastomotic dehiscence 2,3,26 . Clinical parameters, such as intestine color, the presence of peristalsis, mesenteric pulse, active bleeding have historically demonstrated low accuracy to assess the viability of ischemic bowel 12 .…”

Section: ■ Discussionmentioning

confidence: 99%

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

et al. 2017

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Methods: This experimental controlled trial randomly assigned 55 rats to four groups. Anastomoses were performed in non-ischemic colon segments (control group) and in ischemic colon segments measuring 1, 2 or 3 cm long (groups 1, 2 and 3, respectively). Fluorescein was injected and the tissues were examined under ultraviolet light. Seven days later, a second-look surgery was performed to check for the presence or absence of anastomosis dehiscence. Results: Twenty-four rats presented anastomotic dehiscence during the second-look surgery. Reticular and nonfluorescent patterns were significantly associated with the occurrence of anastomotic dehiscence. Fluorescein fluorescence had a sensitivity of 95.8%, specificity of 89.2%, positive predictive value of 88.4%, negative predictive value of 96.2%, and accuracy of 92.3% to predict anastomotic dehiscence. Conclusion: Fluorescein fluorescent test can accurately predict leak in a model of ischemic colonic anastomosis in rats.

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Section: ■ Discussionmentioning

confidence: 99%

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

et al. 2017

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“…It is still a challenging task to distinguish early after surgery the developing septic process from the physiological inflammatory response; however, early diagnosis, before the appearance of clinical symptoms, remains essential for a long term survival [4]. The literature recognizes several risk factors for AL development such as diabetes, smoking, obesity, chronic kidney disease, cardiovascular diseases but facts are still contradictory [5][6][7]. According to several authors [8,9] characteristics of AL depend on many aspects: -The direction of the leakage has a major impact on the patient's symptoms; internal leakages are drained to organs such as the vagina, gallbladder or bladder and external leakages are drained through the teguments.…”

Section: Introductionmentioning

confidence: 99%

The Incidence and Mortality of Anastomotic Leakage after Colorectal Cancer Surgery

Popescu¹,

Sala²,

Gliga³

et al. 2017

Surgery

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Journal of Surgery IntroductionColorectal cancer is one of the most commonly diagnosed cancers worldwide. Its incidence increases with age and higher mortality rate is encountered in men [1]. Therapeutic approach refers to a complex surgical, chemo-and radiotherapy treatment.In spite of numerous surgical techniques developed in the last decades-including new mechanical stapler based methods-anastomotic leakage (AL) remains one of the most feared complications in colorectal surgery. Its incidence ranges from 1.5% to 16% for "per primam" anastomoses with frequent need for redo interventions, longer hospitalization and high mortality rates [2]. AL prediction and identification are still difficult due to its different clinical manifestations, varying from vague abdominal symptoms and prolonged postoperative ileus to fulminant abdominal pain in case of peritonitis and sepsis [3]. It is still a challenging task to distinguish early after surgery the developing septic process from the physiological inflammatory response; however, early diagnosis, before the appearance of clinical symptoms, remains essential for a long term survival [4]. The literature recognizes several risk factors for AL development such as diabetes, smoking, obesity, chronic kidney disease, cardiovascular diseases but facts are still contradictory [5][6][7]. According to several authors [8,9] characteristics of AL depend on many aspects: -The direction of the leakage has a major impact on the patient's symptoms; internal leakages are drained to organs such as the vagina, gallbladder or bladder and external leakages are drained through the teguments. AbstractIntroduction: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery with high mortality rates, prolonged hospitalization, highly risk of readmission, finally generating important costs for any healthcare system. AL prediction and early detection are a considerable challenge for each surgeon as no wellestablished and reliable predictors and diagnosis protocols are currently available. Aims:To determine the incidence and mortality of AL after colorectal surgery, with identification of possible predictors and improvement points in the management of this complication. Material and methods:We included 431 patients with colorectal cancer who underwent surgical resection and restoration of the digestive tube's continuity, at the 2 nd Department of Surgery, Emergency County Clinical Hospital of Târgu-Mureș, from January 2010-December 2015. The patients have been divided in two groups: AL group including 21 patients and no leak group with 410 patients. Demographic characteristics and comorbidities were recorded with clinical and laboratory follow-up in the postoperative period.Results: There were no significant differences between the two groups in terms of demographic characteristics and comorbidities. The average age of patients with AL was 65.9 ± 11.6 vs. 65.0 ± 10.3 without AL. Male gender was predominant in both groups. No significant differences were recorde...

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“…7,8 Risk factors for anastomosis leakage like male sex, advanced age, overweight, low rectal cancer (10 cm from ano-rectal line), 3≥ Charlson index, high ligation of superior mesenteric artery, sepsis, neo-adjuvant chemotherapy, smoking, high American Society of Anesthesiologist (ASA) score, longer operative time (1.9), can be stratified by colon leakage score. 9,10 Intraoperative anastomosis check, good blood supply, tension free and meticulous operative technique are pre-requisites for better anastomosis healing. Protective ileostomy in low anterior rectum resection (ARR) has more advocates than oponents.…”

Section: Introductionmentioning

confidence: 99%

Benefit of extraperitonization to prevent septic intraabdominal complications after distal rectal cancer surgery

Atanasov

Sakakushev

2016

J Peritoneum

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Colorectal cancer is one of the most common oncological diseases. Surgery is the main treatment modality and laparoscopic colorectal resection has been gaining popularity over the past two decades. Neoadjuvant therapy is considered standard treatment for 2 nd and 3 rd stage distal rectal cancer. We present our retrospective study of 127 patients with anterior rectum resection (ARR) and total mesorectal excision (TME) for low rectal cancer operated on between 2012 and 2015 in two surgical wards. In all 59 laparoscopic ARR neoadjuvant therapy, intraabdominal drainage and ileostomy was performed, while extra-peritonization was done in 21 and no pre-sacral drainage was used. In the conventional group of 68 ARR, 21 had neo-adjuvant therapy, everyone has had extra-peritonization, pre-sacral drainage and no protective ileostomy performed. Early postoperative complications were registered in 25 patients, 24 related to the operation and 1 due to a recurrent brain stroke, all classified from I to III by Clavien Dindo scale. There were 9 anastomosis insufficiences: 6 in conventional and 3 in laparoscopic operations. In 3 patients (2 conventional and 1 laparoscopic) with low ARR and signs of peritoneal contamination re-laparotomy was performed with successive outcome. All patients survived. Our routine practice of extra-peritonization and pre-sacral-perianal drainage in open ARR eliminate the possibility of postoperative peritonitis after anastomosis insufficiency, limiting the infection to low pelvic phlegmona and local intra-abdominal pelvic infection in overlooked cases.

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Predicting the Risk of Anastomotic Leakage in Left-sided Colorectal Surgery Using a Colon Leakage Score

Cited by 113 publications

References 63 publications

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

Fluorescent test accurately predicts leak of ischemic colon anastomosis in rats

The Incidence and Mortality of Anastomotic Leakage after Colorectal Cancer Surgery

Benefit of extraperitonization to prevent septic intraabdominal complications after distal rectal cancer surgery

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