Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?

Tsalikidis, Christos; Mitsala, Athanasia; Mentonis, Vasileios I.; Romanidis, Κonstantinos; Pappas-Gogos, George; Tsaroucha, Alexandra; Pitiakoudis, Michail

doi:10.3390/curroncol30030236

Cited by 13 publications

(8 citation statements)

References 224 publications

(328 reference statements)

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“…For instance, anastomotic leakage after colorectal surgery can lead to the serious complications of abdominal and pelvic sepsis, wound infections, fecal incontinence, and tumor recurrence, as well as postoperative death [9][10][11]. The overall incidence of anastomotic leakage after colorectal cancer resection is reported to be 2-19% [12][13][14]. In general, the bursting pressures of the gastrointestinal anastomosis sites are significantly decreased during the first three days, and most leakages after colorectal surgery occur within the first week [15,16].…”

Section: Introductionmentioning

confidence: 99%

Bio-Inspired Self-Healing, Shear-Thinning, and Adhesive Gallic Acid-Conjugated Chitosan/Carbon Black Composite Hydrogels as Suture Support Materials

Shin,

Ryu

2023

Biomimetics

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The occurrence of leakage from anastomotic sites is a significant issue given its potential undesirable complications. The management of anastomotic leakage after gastrointestinal surgery is particularly crucial because it is directly associated with mortality and morbidity in patients. If adhesive materials could be used to support suturing in surgical procedures, many complications caused by leakage from the anastomosis sites could be prevented. In this study, we have developed self-healing, shear-thinning, tissue-adhesive, carbon-black-containing, gallic acid-conjugated chitosan (CB/Chi-gallol) hydrogels as sealing materials to be used with suturing. The addition of CB into Chi-gallol solution resulted in the formation of a crosslinked hydrogel with instantaneous solidification. In addition, these CB/Chi-gallol hydrogels showed enhancement of the elastic modulus (G′) values with increased CB concentration. Furthermore, these hydrogels exhibited excellent self-healing, shear-thinning, and tissue-adhesive properties. Notably, the hydrogels successfully sealed the incision site with suturing, resulting in a significant increase in the bursting pressure. The proposed self-healing and adhesive hydrogels are potentially useful in versatile biomedical applications, particularly as suture support materials for surgical procedures.

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Section: Introductionmentioning

confidence: 99%

Bio-Inspired Self-Healing, Shear-Thinning, and Adhesive Gallic Acid-Conjugated Chitosan/Carbon Black Composite Hydrogels as Suture Support Materials

Shin,

Ryu

2023

Biomimetics

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“…Postoperative anastomotic leaks following oncological right hemicolectomy pose serious complications associated with increased morbidity and mortality [ 5 ]. An international multicenter study reported an overall ileocolic anastomotic leak rate of 7.4%, with 30-day morbidity and mortality rates of 38% and 10.6%, respectively [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Tube Stoma for the Management of Ileocolic Anastomotic Leak in a Patient With Metastatic Colon Cancer

Elsayed

2024

Cureus

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This case involves a 53-year-old male who was diagnosed with stenotic ascending colon cancer and peritoneal metastatic deposits. He was initially planned for cytoreductive surgery and heated intraperitoneal chemotherapy (CRS and HIPEC), along with resection of the primary tumor in the form of right hemicolectomy. Intraoperatively, the disease was found to be more extensive than anticipated. Consequently, the plan was modified to include debulking right hemicolectomy with hand-sewn ileocolic anastomosis and extensive peritoneal procedures. Postoperatively, he experienced an anastomotic leak, leading to another laparotomy. However, due to anatomical challenges, creating a stoma was considered unsafe. Therefore, innovative interventions were performed, including controlling the anastomotic defect with a 30Fr Foley catheter without disrupting the anastomosis. A collaborative effort from various medical teams facilitated the patient's discharge home after an extended stay in the critical care unit (CCU).

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“…It was also reported that patients receiving neoadjuvant chemoradiotherapy also pose a risk of anastomotic leakage. The rate of anastomotic leakage varied greatly in published series, reported between 2% and 19%, but in reference centers and with experienced teams, it is 2-7% [ 14 ]. Although we have a robust anastomotic leakage rate, our study revealed that we should strive to reduce our overall complication rate after colorectal cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates

Rasa,

Erdemir

2023

Cureus

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Background: Evidence about the importance of sarcopenia in patients operated on for gastrointestinal cancers and that it may have both early and long-term impacts is expanding. In our study, we aimed to evaluate the impact of sarcopenia on the outcomes of the patients we operated on for left colon and rectum cancer. Methods: We retrospectively evaluated the electronic records of 38 patients operated on for left colon and rectal cancer between 2010 and 2020, and demographic variables, clinical stages, laboratory tests, body mass index (BMI), psoas muscle index (PMI), pathological stages, and Dindo Clavien complication scores were interpreted. We also assigned our patients into two groups according to their preoperative PMI values. We compared the first group of 12 patients with preoperative sarcopenia with the second group of 26 patients without preoperative sarcopenia. Results: Of the 38 patients who underwent curative surgery for left colon and rectal cancer, 20 were female and 18 were male. The median age of the group was 59.9 years. The most common tumour localization was in the rectosigmoid region in 17 patients, and the tumour in 6 patients was in the left colon. Therapy had been initiated with neoadjuvant treatment in 19 patients. At the preoperative evaluation, sarcopenia was present in 12 patients. Thirty-four patients underwent robot-assisted surgery. Postoperative pathologies were reported as stage 3 in 15 patients. Complications were reported in 17 patients, and nine were minor (Dindo-Clavien score < 3), but in eight patients, they were moderate to severe (Dindo-Clavien score ≥ 3). When the first group, 12 patients with preoperative sarcopenia, and the second group, 26 patients without preoperative sarcopenia, were compared, the patients with sarcopenia were found to be older (p=0.001), and male patients were in the majority (p=0.017). The postoperative follow-up of 12 patients with preoperative sarcopenia revealed that 7 (58.8%) had complications. Complications were observed in 10 (38.4%) patients in the second group. When the two groups were compared, the risk of developing complications was significantly higher in the sarcopenia group (p=0.016). Only one patient in the first group had moderate to severe complications, but seven patients without sarcopenia had moderate to severe complications. Conclusion: Our study revealed that many patients we have operated on for left colon and rectal cancer have preoperative sarcopenia for which we should care. The sarcopenia rate was higher in males and elderly patients, and the risk of overall postoperative complications increased significantly in patients with preoperative sarcopenia. In consequence, the results of our study provide evidence that preoperative sarcopenia status is an important parameter to determine the risk status of the patient, and patients with preoperative sarcopenia should be monitored more closely. Thus, we may be able to diagnose and intervene early in the complications.

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Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?

Cited by 13 publications

References 224 publications

Bio-Inspired Self-Healing, Shear-Thinning, and Adhesive Gallic Acid-Conjugated Chitosan/Carbon Black Composite Hydrogels as Suture Support Materials

Bio-Inspired Self-Healing, Shear-Thinning, and Adhesive Gallic Acid-Conjugated Chitosan/Carbon Black Composite Hydrogels as Suture Support Materials

Tube Stoma for the Management of Ileocolic Anastomotic Leak in a Patient With Metastatic Colon Cancer

Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates

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